Occupational safety and health in Europe : state and trends 2023.
Date: 2023-09-08
Institutions: European Agency for Safety and Health at Work
Subjects: EU Member State, European Agency for Safety and Health at Work, accident prevention, health legislation, health risk, occupational safety, safety standard, social well-being, technological change, workplace

European Agency for Safety and Health at Work

ISSN 1831-9343

EN

Occupational safety and health in Europe: 
state and trends 2023 

Safety and health at work is everyone’s concern. It’s good for you. It’s good for business.

Occupational safety and health in Europe - state and trends 2023 

Neither the European Agency for Safety and Health at Work nor any person acting on behalf of the agency is responsible for the 
use that might be made of the following information. 

Luxembourg: Publications Office of the European Union, 2023 

PDF 

ISBN 978-92-9479-935-7 

doi: 10.2802/56459 

ISSN 1831-9343 

TE-RO-23-001-EN-N 

© European Agency for Safety and Health at Work, 2023 

Reproduction is authorised provided the source is acknowledged. 

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The photographs used in this publication illustrate a range of work activities. They do not necessarily show good practices or 
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https://osha.europa.eu/en/publications/occupational-safety-and-health-europe-state-and-trends-2023 

European Agency for Safety and Health at Work – EU-OSHA 

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Occupational safety and health in Europe - state and trends 2023 

Contents 
List of figures .......................................................................................................................................... 5 

List of tables ........................................................................................................................................... 7 

Foreword by Nicolas Schmit, European Commissioner for Jobs and Social Rights .............................. 8 

Acknowledgements ................................................................................................................................ 9 

1 

2 

3 

Executive summary ................................................................................................................... 10 

Setting the scene ....................................................................................................................... 20 

Status of working conditions ...................................................................................................... 23 

3.1  Psychosocial risks at work ......................................................................................................... 24 

3.1.1  Working time in hours and at atypical times ................................................................... 29 

3.1.2  Work intensity ................................................................................................................. 33 

3.2  Physical health risks at work ..................................................................................................... 38 

3.3  Contract types and work locations ............................................................................................. 45 

3.4  Mobile work, home as workplace and domestic work ............................................................... 49 

3.5  Worker groups with specific risks and needs ............................................................................ 54 

3.6  Conclusions ............................................................................................................................... 59 

4 

Trends in outcomes – safety, health and wellbeing .................................................................. 61 

4.1  Trends in safety outcomes – work accidents ............................................................................ 61 

4.1.1 

4.1.2 

Non-fatal work accidents ................................................................................................ 64 

Serious non-fatal and fatal work accidents ..................................................................... 71 

4.2  Trends in health outcomes ........................................................................................................ 73 

4.2.1 

4.2.2 

4.2.3 

Statistical picture of mortality and morbidity ................................................................... 77 

Attributable fractions, risk pairs and burden of disease .................................................. 81 

Examples of specific prevalence estimates .................................................................... 86 

4.3  Wellbeing and health status ...................................................................................................... 89 

4.3.1 

4.3.2 

4.3.3 

Satisfaction at work ......................................................................................................... 89 

Health affected – overall opinion .................................................................................... 91 

Reported health problems .............................................................................................. 92 

4.3.4  Working life perspective – health .................................................................................... 96 

4.3.5 

Summary of survey results on wellbeing and health status ........................................... 98 

4.4  Conclusions ............................................................................................................................... 99 

5 

Major context developments and their influence on working conditions ................................. 101 

5.1  Changes from industrial to service sectors ............................................................................. 101 

5.2  Technological developments – influence on OSH ................................................................... 103 

5.3  Workforce structure ................................................................................................................. 109 

5.4  Globalisation and OSH ............................................................................................................ 114 

6 

OSH legislation and OSH infrastructure in the EU .................................................................. 118 

6.1  Foundation, legislation, compliance and supervision .............................................................. 118 

6.2  EU and national OSH strategies .............................................................................................. 124 

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Occupational safety and health in Europe - state and trends 2023 

6.3  Guidance and support ............................................................................................................. 125 

6.4  Prevention practices in enterprises ......................................................................................... 127 

6.5  Conclusions ............................................................................................................................. 130 

7 

Methodological approaches, available data and research questions ...................................... 131 

7.1  The need for a detailed OSH information base ....................................................................... 131 

7.2  Quantitative data on OSH ........................................................................................................ 131 

7.3  Qualitative data and research .................................................................................................. 134 

7.4  Data and research – major evidence difficulties at EU level ................................................... 136 

7.4.1 

7.4.2 

7.4.3 

Variety of OSH systems ................................................................................................ 137 

Reliable and measurable indicators ............................................................................. 137 

Relationship between preventive actions and outcomes ............................................. 139 

7.4.4  On the way to better evidence – major data, research gaps and open questions ....... 139 

European Agency for Safety and Health at Work – EU-OSHA 

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Occupational safety and health in Europe - state and trends 2023 

List of figures 
Figure 1: Risk factors present (% of establishments) – ESENER 2014 and 2019................................ 23 

Figure 2: Risk factors that can adversely affect mental wellbeing – EWCS  and ESENER ................. 24 

Figure 3: ‘Exposure to risk factors adversely affecting mental wellbeing’ – LFS Ad hoc survey 2020 . 26 

Figure 4: Psychosocial risk factors – Differences between skill groups (Job strain)............................. 27 

Figure 5: Psychosocial risk factors – Differences between skill groups (Psychological demand) ........ 28 

Figure 6: Psychosocial risk factors – Differences between skill groups (Decision authority) ............... 28 

Figure 7: Psychosocial risk factors – Differences between skill groups (Skill discretion) ..................... 29 

Figure 8: Hours worked per week of full-time employment, EU27 – Eurostat ...................................... 31 

Figure 9: Average working time and work during unsocial hours – Eurostat LFS ................................ 32 

Figure 10: Development of work intensity indicators between 1991 and 2015 – Eurofound ................ 33 

Figure 11: Establishment size and ‘Pressure due to time constraints’ – ESENER 2014 and 2019 ...... 34 

Figure 12: Establishment size and ‘Long or irregular working hours’ – ESENER 2014 and 2019 ....... 34 

Figure 13: ‘Pressure due to time constraints’, Yes responses – ESENER 2019 .................................. 35 

Figure 14: Employed persons and percentage of working time under pressure – Eurostat LFS Ad hoc 
2019 ....................................................................................................................................................... 35 

Figure  15:  Percentage  of  employed  persons  with  working  time  under  pressure  (per  country,  sum  of 
responses ‘Always’ and ‘Often’) – LFS Ad hoc 2019 ............................................................................ 36 

Figure 16: Exposure to physical risks – ESENER, EWCS and LFS ..................................................... 39 

Figure 17: Physical health risks compared (%) – EWCS 2015 ............................................................. 42 

Figure 18: Employment types in EU27, development 2005 to 2022  – Eurostat .................................. 47 

Figure 19: Employed persons by main place of work – Eurostat .......................................................... 51 

Figure 20: Employees working mostly from home (in % of employed persons) – Eurostat .................. 52 

Figure 21: Development of the total number of non-fatal accidents at work and incidence rates (accidents 
per 100,000 workers), 1998 and 2019 – Eurostat ................................................................................. 65 

Figure 22: Share of people reporting any accident and accidents resulting in time off work by country, 
2020 ....................................................................................................................................................... 70 

Figure 23: Comparison of the average incidence rate of fatal accidents in two periods: 2010-2014 and 
2015-2020 ............................................................................................................................................. 71 

Figure 24: Main causes of mortality 2019, EU27 .................................................................................. 79 

Figure 25: Work-related deaths – estimates by WHO/ILO and ICOH for EU27 ................................... 83 

Figure 26: Work-related DALYs – estimates by WHO/ILO and ICOH for the EU27 ............................. 84 

Figure 27: Prevalence of musculoskeletal diseases – EWCS 2015 ..................................................... 88 

Figure 28: Satisfaction with working conditions in the main paid job – EWCS 2015 ............................ 89 

Figure 29: Flash Eurobarometer 2014 – Satisfaction with health and safety at work ........................... 90 

Figure 30: ‘Health at risk’, sectoral responses for EU and three countries – EWCS 2015 ................... 91 

Figure 31: ‘Health at risk’, responses in groups of EU Member States – EWCS .................................. 92 

Figure 32: Age classes and work-related health problems in 2007, 2013, 2020 – LFS ad hoc module93 

Figure 33: People reporting a work-related health problem and People reporting a work-related health 
problem causing daily limitations 2020 – LFS Ad hoc module 2020 ..................................................... 94 

European Agency for Safety and Health at Work – EU-OSHA 

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Occupational safety and health in Europe - state and trends 2023 

Figure 34: People reporting a work-related health problem by occupational category 2020 – LFS Ad hoc 
module 2020 .......................................................................................................................................... 95 

Figure 35: Opinion on work until the age of 60 – EWCS 2015.............................................................. 96 

Figure  36:  Comparison  of  responses  to  self-rated  work  satisfaction,  health  risks  and  working  life 
perspectives – Flash Eurobarometer, LFS and EWCS ......................................................................... 98 

Figure 37: Share of 10 main economic activities in EU total employment 1996 and 2019 (%), EU28 – 
Eurostat ............................................................................................................................................... 102 

Figure 38: Workforce structure, demography – Eurostat .................................................................... 109 

Figure 39: Workforce structure, skill levels – Eurostat ........................................................................ 111 

Figure 40: Workforce structure, mobility and migration – European Commission .............................. 112 

Figure 41: Posted workers, receiving and sending countries in the EU .............................................. 114 

European Agency for Safety and Health at Work – EU-OSHA 

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Occupational safety and health in Europe - state and trends 2023 

List of tables 
Table 1: Psychosocial risks, Top countries ‘All Sectors’ and ‘Human health and social work’ – ESENER 
2019 ....................................................................................................................................................... 26 

Table 3: Physical risks present in enterprises EU27 (in %) – ESENER 2014 and 2019 ...................... 40 

Table 4: Physical risks (in %) – EWCS 2005, 2010 and 2015 .............................................................. 41 

Table 5: Physical risks (in %) – LFS Ad hoc Survey ............................................................................. 41 

Table 6: Physical health risks, Sectors and exposures – EWCS 2015 ................................................. 42 

Table 7: Physical health risks, Ergonomics – EWCS 2015 ................................................................... 44 

Table 8: Physical health risks, Ergonomics – EWCS 2015 ................................................................... 44 

Table 9: Posted and seasonal workers – Eurostat ................................................................................ 48 

Table 10: Types of work: in, at and from home ..................................................................................... 50 

Table 11: Accidents at work and health-related work problems, women and men – Eurostat ............. 56 

Table 12: Time spent for household and family care, men/women –  Eurostat .................................... 57 

Table 13: Non-fatal and fatal accidents at work – incidence rate by age – Eurostat ............................ 57 

Table  14:  Crossovers  of  health  and  safety  risks  among  groups  of  workers  (2010)  –  DG  for  Internal 
policies, policy department .................................................................................................................... 58 

Table 15: Accidents at work by physical activity 2019 – Eurostat ......................................................... 63 

Table 16: Incidence rates of non-fatal accidents per sector in 2010 and 2019 (EU27) ........................ 66 

Table 17: Non-fatal accidents estimated via coefficient of fatal accidents, 4 benchmark countries ..... 67 

Table 18: Self-reported work accidents during the last 12 months (EU27) – LFS Ad hoc modules ..... 68 

Table 19: People reporting an accident by group of occupations (ISCO) – LFS Ad hoc 2020 ............. 69 

Table 20: Incidence rates of fatal accidents per sector in 2010 and 2019 (EU27) ............................... 71 

Table 21: Severity of accidents in the EU27 in 2019 (sectors A and C-N) ........................................... 72 

Table 22: Development of recognised occupational diseases in the EU 2013-2019 ............................ 74 

Table 23: Life expectancy by age and sex - in years at the age of 65 .................................................. 78 

Table 24: People reporting work-related health problems by group of occupations (ISCO) – LFS Ad hoc 
2020 ....................................................................................................................................................... 80 

Table 25: Examples of fractions of diseases attributable to work (AF) – WHO/ILO ............................. 82 

Table 26: Summary Burden of diseases EU27, Global deaths – WHO/ILO 2016, ............................... 85 

Table 27: Summary Burden of diseases table DALYs WHO/ILO ......................................................... 85 

Table 28: Opportunities and risks of ICT-based mobile work – Eurofound ......................................... 105 

Table 29: Digitalisation and OSH discussed – ESENER 2019 ........................................................... 106 

Table 30: Production and consumption of chemicals by hazard class in the EU in 2019 – Eurostat . 107 

Table 31: Development of male and female workforce in the EU27 between 2005 and 2019 ........... 110 

Table 32: Average age of the EU27 workforce ................................................................................... 110 

Table 33: Non-EU Migrants – over-represented in certain sectors and occupations in 2019 ............. 113 

Table 34: EU Directives on Occupational Safety and Health .............................................................. 120 

European Agency for Safety and Health at Work – EU-OSHA 

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Occupational safety and health in Europe - state and trends 2023 

Foreword  by  Nicolas  Schmit,  European  Commissioner  for 

Jobs and Social Rights 

Occupational safety and health (OSH) has been at the heart of the 
European  project  since  the  very  beginning.  OSH  concerns  all 
European citizens whether they work in a factory, in an office, sell 
goods  in a shop  or take care of patients  in a  hospital. Health and 
safety at work is an essential part of any organisation’s operations.  

This  is  why  EU  policy  and  legislation  on  OSH,  based  on  both 
scientific and technical evidence and data, is a vital policy area for 
EU society and all of its citizens.  

“Occupational safety and health in Europe – state and trends 2023” is a very important contribution from 
the  European  Agency  for  Safety  and  Health  at  Work  (EU-OSHA).  The  Agency’s  analysis  is  also 
particularly  timely,  as  the  EU  takes  stock  of  progress  made  under  the  2021-2027  EU  Strategic 
framework on health and safety at work. 

This publication originates from a European Commission initiative, supported by its tripartite Advisory 
Committee  on  Health  and  Safety  at  Work,  to  create  a  comprehensive  EU  OSH  Information  System. 
Work in this area started in 2015 and the project was later transferred to EU-OSHA which together with 
the Commission put the information system online under the title of “EU OSH Barometer”.  

This particularly useful tool, notably for the stakeholders in this policy area, provides, on a permanent 
basis, graphical information for significant OSH indicators at EU and national level, drawing on statistics, 
surveys  and  public  data.  This  first  analytical  report  combines  the  quantitative  data  of  the  EU  OSH 
information system with explanatory and analytical descriptions of trends that reach back between 10 
and 25 years. The intention is to repeat this exercise on a regular basis, so that it can provide knowledge 
and insights for safer and healthier work, in an ever-changing world of work, to wider audiences.   

Changes at the workplace, caused by the COVID crisis, the green, digital and demographic transitions, 
as well as by scientific and technological progress, led the Commission to adopt, in June 2021, a new 
2021-2027 EU Strategic framework on health and safety at work.  

The Framework is part of the Commission’s commitment to building a strong social European Union that 
protects. This is the foundation of all the initiatives that we are proposing. Every action we take in social 
policy comes under the umbrella of the European Pillar of Social Rights Action Plan that we presented 
in March 2021. The protection of workers’ health and safety, enshrined in the EU Treaties and in the 
Charter of Fundamental Rights, is one of the key elements of an EU economy that works for people. In 
particular, the right to a healthy and safe workplace is reflected in principle 10 of the European Pillar of 
Social Rights, and is fundamental for reaching the United Nations’ sustainable development goals. Our 
determined action to improve occupational safety and health and to consolidate a culture of prevention 
represents a substantial contribution to the objectives of the abovementioned Pillar. 

The work of EU-OSHA is essential in this respect and this publication is a good example of the strong 
commitment  shown  by  EU  governments  –  and  also  employer  and  trade  union  organisations  -  to 
continuously improve OSH in Europe.  

Nicolas Schmit 

European Agency for Safety and Health at Work – EU-OSHA 

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Occupational safety and health in Europe - state and trends 2023 

Acknowledgements 
EU-OSHA wishes to thank the European Commission, Directorate-General for Employment, Social 
Affairs and Inclusion for their contributions and support, in particular Matthias Fritz. 

Thanks to Jukka Takala, Subas Neupane and Päivi Hämäläinen for the provision of their estimates of 
the global burden of disease. EU-OSHA also thanks Frank Pega and Natalie Momen from the World 
Health Organization (WHO) for the kind provision of an extract of EU27 data from its Occupational 
Burden of Disease database. Joana Soares and Réka Zayzon have meticulously checked data and 
calculations of this report. 

Lead author: Lothar Lieck (EU-OSHA) 

Co-authors and contributors: Ioannis Anyfantis, Xabier Irastorza, Lorenzo Munar, Birgit Müller, 
Malgorzata Milczarek, William Cockburn, Andrew Smith (EU-OSHA).  

Find  more  up-to-date  information  and  data  on  occupational  safety  and  health  in  Europe  in  the  OSH 
Barometer data visualisation tool: https://visualisation.osha.europa.eu/osh-barometer 

The  tool  informs  on  a  large  range  of  OSH  indicators,  such  as  work-related  accidents,  diseases  and 
wellbeing as well as working conditions and prevention. It also presents the national OSH authorities 
and strategies, economic and sector information, and enforcement capacity. 

You can visualise and compare country data, generate graphics and download a report of all data per 
country. The OSH Barometer is updated regularly with new indicators, data, publications and features. 

European Agency for Safety and Health at Work – EU-OSHA 

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Occupational safety and health in Europe - state and trends 2023 

1  Executive summary 
How can the ‘state of OSH’ in the EU be assessed? 

This report describes the state of OSH in the EU, and accordingly the trends and the developments, 
that is, the changes in state over time. The report refers to different periods in time, mostly to the situation 
between 2005 — after the substantive enlargement of the EU in 2004 — and 2019; if the use of earlier 
or more recent start or endpoints was reasonable and data were available, a different time frame was 
applied.  

Two criteria were crucial for the selection of these indicators: availability of reliable data and the 
relevance of the indicators. An ideal and complete set of indicators would cover even more indicators 
than presented in this report, but major limits were set by the availability of reliable data.  
The  main  data  sources  comprise  a  large  variety  of  quantitative  datasets,  for  example,  Eurostat 
statistics and EU-wide surveys (e.g. EU-OSHA’s European Survey of Enterprises on New and Emerging 
Risks (ESENER), Eurofound’s European Working Conditions Survey (EWCS), Eurostat’s Labour Force 
Survey (LFS) and its ad hoc modules, and the Flash Eurobarometer, detailed background reports on 
risks,  groups  of  workers,  OSH  systems  and  infrastructures  (e.g.  by  EU-OSHA,  Eurofound,  the 
Fundamental Rights Agency, etc.), and evaluations and assessments of the level of implementation of 
OSH  directives  (e.g.  by  the  Directorate-General  for  Employment,  Social  Affairs  and  Inclusion  (DG 
EMPL) or the Senior Labour Inspectors Committee (SLIC) surveys facilitated by the National Labour 
Inspectorates). Regarding the description of developments beyond the EU, data were taken from the 
International Labour Organisation (ILO), the World Health Organisation (WHO), the International Social 
Security Association (ISSA), the United Nations (UN), the Organisation for Economic Co-operation and 
Development  (OECD),  the  International  Commission  on  Occupational  Health  (ICOH)  and  the 
International Association of Labour Inspection (IALI).  

Please note that Eurostat employment data and ICOH data were retrieved in 2023. Current figures 
might slightly deviate due to updates and corrections. 

Working conditions – Risk factors at work  

Shifts in work tasks and workforce between sectors, technological progress and the develop-
ment of higher skill levels have led to less work in manual occupations and more work in administrative 
(clerical,  professional,  managerial,  etc.)  occupations  as  well  as  in  client-oriented  and  communicative 
occupations.  

Consequently,  these  developments  caused  a  shift  of  risks  to  psychosocial  and  emotional 
challenges. This can be documented by the growing percentage of workers who report difficult clients 
(60%), long or irregular working hours (22%), and poor communication in the organisation (18%) (all 
data from ESENER 2019 or EWCS 2015) The OSH risks for these occupations — gradually but also 
significantly — shifted from safety risks to health risks. The psychosocial risks for mental health and the 
emotional challenges increased; they clearly correlate with more work in emotionally demanding and/or 
client-oriented  sectors,  be  it  in  tourism,  entertainment  or  education,  public  transport,  social  work,  or 
health and care.  

The trend towards more psychosocial and emotional challenges at work does not mean that ‘classical’ 
exposures  or  ergonomically  burdensome  work  has  disappeared.  There  is  a  large  number  of 
workers in all sectors — between 40% and 75% in ESENER and the EWCS — who report ergonomic 
risks. These are, for example, repetitive hand and arm movements in industry and service occupations, 
where a particularly high percentage is reported by low-skilled manual workers; moving heavy loads in 
craft occupations, or patients in health and care occupations, where a particularly high percentage is 
reported by high-skilled manual workers; and tiring and painful positions, where again the highest level 
is reported by high-skilled manual workers. 

Still a quite constant share of workers reports exposure to physical risks like noise, vibrations, high 
or low temperatures and to chemical and biological agents; depending on occupation and sector, 
between 15% and 30% of workers are exposed to such risks (EWCS). No or very minor decreases in 
these risks can be seen during the past 15 years.  

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Occupational safety and health in Europe - state and trends 2023 

In several occupations, classical safety risks often add to the above-mentioned exposures, that is, 
slips, trips and falls, risks related to moving parts of machinery, moving vehicles, exposure to hot, cold, 
or  hazardous  materials,  loud  noise,  chemical  or  biological  substances,  and  in  general  physically 
exhaustive work. 

A certain ergonomic risk of many administrative and supervisory jobs is physical inactivity (61%), in 
practice meaning sitting most of the working time in front of digital equipment, sitting to make phone 
calls or sitting in meetings. Not only administrative tasks but also many occupations in transport and 
industry require prolonged sitting (transport, cashiers, parts assembly, etc.).  

In the 10-year period before 2005, EU-wide surveys found a significant increase in work intensity. Major 
differences in work intensity and working time patterns can be seen between occupations, forms of work, 
sectors and enterprise size, for example. The length of the daily or weekly working time and its allocation 
with the 24 hours of a day or at night are important factors for health and wellbeing. The Eurostat data 
show a slight decrease in the average weekly working time for full-time employees (15-64 years) 
from 40.2 to 39.9 hours between 2006 and 2019.  

Eurostat reports for  all types of ‘employment at atypical working time’  a minor decrease between 
2011 and 2019, from 38.8% to 37.2% (EU27 average), for all employed workforce and all types of such 
atypical time. The data also document slight increases or decreases of the different types of work during 
atypical times > on  Saturdays the percentage decreased from 28% to  25%, working in the evenings 
decreased from 19% to 15%, working on Sundays remained stable at around 13.5%, work at night fell 
from 7% to 5%, and shift work increased slightly from 17% to 18%. Some groups of self-employed 
show a higher rate of atypical working times: for high-managerial self-employed, this rate is 43.2% 
and for low-managerial self-employed 64.5%. 

Significant  differences  also  exist  between  eastern/southern  and  central/northern/western 
European countries. More physical and ergonomic risks (except inactivity) are reported from eastern 
and southern EU Member States but more emotional demands (e.g. difficult clients, poor communication 
and long working hours) in northern and central European countries. One of the major reasons might 
be the reallocation of industrial production to eastern countries after the EU extension to 24 and later to 
27 Member States. 

Conditions of employment and workforce development  

During the past decades and at faster pace after 1990, a greater variety of non-standard contractual 
relations has emerged. Typical characteristics of non-standard work are part-time work, temporary (or 
fixed-term) work, seasonal work, casual work, home-based work, telework, self-employment or family 
work.  Currently,  high  public  awareness  is  directed  to  those  types  of  non-standard  work  that  are 
connected either to new forms of contracts (voucher, platform, zero-hours, portfolio, etc.) or increasing 
types of work not bound to the premises of the employer (mobile, at home, at client’s place), mostly 
made  possible  by  the  increased  use  of  modern  information  and  communication  technologies  (ICT). 
These  forms  of  work  often  have  as  a  —  additional  —  major  characteristic  a  less  clear  employer–
worker relationship.  

However, in 2019 the conventional employment contract still accounted for around 86% of the workforce 
(EU27), 9% are ‘own-account’ workers, that is, self-employed without employees. The remaining 4% 
were self-employed with employees (employers) and less than 1% were contributing family workers. Of 
all employed workers, 17.2% worked part-time and 13.3% had temporary contracts.  

Non-standard  types of work that are characterised  by the circumstance that  the work  is not taking 
place at the premises of the employer are mobile and home-based work, domestic work, care work 
and long-term domestic care work, and online platform work. In 2019, approximately 77% worked at the 
employer’s premises, 5% at home, 9% at the clients’ places and 8% at non-fixed workplaces. With the 
onset of the COVID-19 pandemic in 2020, the share of work at home more than doubled; in the EU27 it 
increased from 5.4% in 2019 to 13.4% in 2021.  

Compared to work at  the  premises of  the  employer, such non-standard workplaces often miss basic 
OSH facilities (Minimum requirements at workplaces directive), availability and suitability of help tools 
(Work equipment directive and Personal protective equipment directive), or provision of adequate digital 
and mobile tools (Display screen equipment directive). 

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Occupational safety and health in Europe - state and trends 2023 

The workforce structure also significantly changed during the past 15 years, requiring new or adapted 
prevention solutions, organisationally and technically.  

Statistics show a growing share of employment rates of female workers; between 2005 and 2021, 
the  employment  (activity)  rate  of  women  expanded  from  56%  to  67.7%.  In  2005,  approximately 
80 million women and 101 million men were employed in the EU. In 2005, this made the share of the 
female  workforce  44.1%,  and  in  2021  this  rate  went  up  to  46.1%,  that  is,  90.2  million  women  and 
105.6 million men, together totalling 195.8 million.  

The share of older workers — between 55 and 64 years old — increased significantly, from 11.1% 
(2005) to 18.4% (2019). This corresponds to a growth from 20.1 million to 35.9 million employed persons, 
or of 79%. 
The migrant workforce in the EU27 also increased in the past two decades. The majority of migrants 
are intra-EU, that is, all workers who are born in a Member State other than the one where they currently 
work  and  reside;  this  number  is  estimated  at  10.4  million  (2019),  based  on  LFS  data.  Cross-border 
workers account for another 1.5 million and posted workers for 2.4 million. In 2020, 8.6 million extra-EU 
citizens (born outside the EU) were employed in the EU labour market, out of 196 million persons aged 
from 20 to 64 years, corresponding to 4.4% of the total. The sum of all different categories of mobile 
extra- and intra-EU workers is roughly 23 million, or about 12% of the EU workforce.  

When comparing 2005 with 2020, for most occupations higher skills are required. In this period, the 
share of occupations requiring the three lowest education levels fell from 24.5% to 15.5%; the share of 
occupations that require a tertiary education grew from 24.9% to 36.4%. 

Accidents at work 

Accidents at work are the most common indicator regarding the quality of prevention in an enterprise, 
a  sector  or  a  country.  Between  1998  and  2019  (EU  level),  the  incidence  rate  of  non-fatal  work 
accidents fell about 58%, from 4,089 to 1,713. Most of this decrease took place in the first half of this 
decade. Between 1998 and 2008, the incidence rate fell by 54%, and between 2009 and 2019 by 9%.  

Between 1998 and 2019, the incidence rate for fatal accidents dropped about 57% from 5.03 to 2.17, 
almost the same decrease as for non-fatal accidents.  

Four major sectors, agriculture, manufacturing, construction and transport, employed just under 
40% of the workforce (in 1998 as well as in 2019). However, in 1998, more than 60% of the accidents 
at work took place in these sectors, thus the reduction of accidents in these sectors was crucial for the 
overall reduction. In addition, economic developments — sector decline and shift of workforce between 
sectors — reduced the number of workers exposed to common safety risks in these sectors.  

There have always been concerns in national or sectoral case studies about underreporting of work 
accidents for different reasons: accidents suffered by self-employed who are not obliged to notify or 
are insured via private or non-occupational public health insurances, work-related traffic accidents that 
are  reported  as  traffic  accidents  only,  declaration  of  less  severe  accidents  as  private  to  avoid 
administrative burden, administrative burden in general. This leads to several approaches to estimate 
the true number of accidents at work. Currently, these estimates result in figures of around 5.45 million 
work accidents at EU27 level in 2019 for all economic sectors and all types of employment. That means 
that the reported 3.14 million accidents represent approximately 57.5% of all work accidents resulting in 
more than three days of absence, while 42.5% are not reported.  

The pure distinction between fatal and non-fatal work accidents does not reveal that a very large part of 
the human and financial burden is caused by severe but not fatal accidents. In 2019, 232,892 work 
accidents resulted in an absence of more than three months or caused a permanent disability, compared 
to 3,008 fatal accidents (NACE Rev. 2 activity A, C-N). That is, in addition to every worker who dies, 
another 77 suffer injuries resulting in at least three months off work or in permanent disability. 

Work-related deaths and diseases 

Work-related health outcomes represent a much  higher burden for society  than  work accidents. 
More workers are affected, and the overall costs are much higher. When limiting the scope of analysis 
to the officially recognised occupational diseases, the trend of health outcomes (deaths, illnesses) 
caused by ‘exposures’ at work decreases similarly to the accident trend.  

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Eurostat’s new experimental European Occupational Diseases Statistics (EODS) indicates a decrease 
in some of the major recognised diseases due to technical preventive measures and to a shift of the 
workforce to sectors with less ‘classical’ exposures and related recognised occupational diseases.  

EU-OSHA  has  been  engaged  in  several  research  efforts  to  estimate  the  burden  of  work-related 
diseases, including their economic impact (this work is being continued by ICOH). The impact of the two 
major  health  consequences  (‘Outcomes’)  was  calculated,  that  is,  work-related  deaths  and  work-
related diseases, measured in DALYs (lost life years due to disability, or in other words: one DALY is 
one lost year of healthy life).  

This report presents two estimates, one from WHO/ILO and one from ICOH. In 2021, the WHO and 
ILO jointly published estimates of the burden of work-related diseases for the period 2000-2016. The 
WHO/ILO calculate for the EU27 114,000 work-related deaths in 2016. When setting the absolute 
number  of  work-related  deaths  (114,000)  in  relation  to  the  EU27  population  above  16  years  (371 
million), this gives a result of approximately 31 deaths per 100,000 population of working age above 
age 16.  

For 2019, ICOH estimates 179,000 deaths in total; moreover, they refer to the much smaller labour 
force population (201 million) and calculate 88 work-related deaths per 100,000 labour force.  

These estimates also provide figures on the relation between major risks and the health outcome in 
DALYs.  The  DALYs  that  are  attributable  to  work  vary  between  6.8  million  life  years  (ICOH)  and  4.4 
million life years (WHO/ILO) for the EU27.  

The main reason for these different estimates is the general approach: The WHO/ILO used a different 
methodological approach and restricted their analysis to selected risk–outcome pairs, for example, long 
working hours as risk and stroke as outcome, whereas ICOH aspires to cover all work-related diseases. 

It can be concluded that despite methodological differences, the estimates do not vary that much if 
the same reference population is used in the calculation. Future research will contribute to a better 
attribution of the impact of work on these diseases. Additionally, the impact of work on the prevalence 
of mental diseases will be incorporated in future estimates.  

Wellbeing and health  

Existing concepts of wellbeing cover more aspects of work than working conditions or safety and health 
at work. Eurofound mentions as the most relevant components: income, working time arrangements, 
possibilities for skills development and career advancement, and the degree of individual control over 
work. 

ILO defines wellbeing at work under the term ‘Workplace Wellbeing’: ‘Workplace Wellbeing relates to 
all aspects of working life, from the quality and safety of the physical environment, to how workers feel 
about  their  work,  their  working  environment,  the  climate  at  work  and  work  organization.  The  aim  of 
measures for workplace well-being is to complement OSH measures to make sure workers are safe, 
healthy, satisfied and engaged at work.’ 

A common methodology to collect data on health status and wellbeing is self-reporting and self-
assessment of risks at work, health risks and health problems, absence, job satisfaction and working 
life perspectives from a health point of view. This allows insight into the subjective assessment of health 
risks at work and wellbeing.  

Indicators on wellbeing and satisfaction at work show similar patterns to health and work accidents. 
Sectors with high physical demands and high customer and client orientation and occupations with a 
lower skill level report lower wellbeing and satisfaction levels; they report a good health status but fewer 
expectations to be able to work in this occupation until the age of 60 years. Concerning the levels of 
self-reported ‘Health at risk’, the LFS Ad hoc module on ‘Accidents at work and other work-related 
health  problems’  suggests  that  the  situation  has  improved.  According  to  the  LFS,  in  2007  14.6%  of 
employed persons reported a work-related health problem; this figure decreased in 2013 to 8.8% and 
went slightly up again — during the pandemic — to 10.3% in 2020 (EU27 level). 

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Safer and healthier technologies and organisation 

To  support  the  practical  implementation  of  preventive  safety  and  health  measures,  numerous 
actors (e.g. organisations of OSH professionals and practitioners, and standardisation institutes such 
as the European Committee for Standardisation and the International Organisation for Standardisation) 
issued safety and health guidance or standards, or developed new and advanced OSH management 
systems, the engineering sciences worked on better technical preventive technologies, on measuring 
and monitoring technologies, the medical sciences introduced better medical diagnosis and treatment 
of work-related diseases, and the social sciences contributed with better knowledge on the legal and 
economic  determinants  of  OSH,  or  analysed  the  characteristics  of  awareness  raising,  knowledge 
development and healthy work organisation.  

It is obvious that better technical and organisational prevention at work contributed to more safety 
and the evident strong reduction in accidents. Prominent fields and examples of such improvements 
are: technically safer design of moving vehicles (e.g. for fork lifts or heavy trucks and machines, light 
and noise warning signals for moving vehicles); safer design of machines like automatic shutdowns or 
disconnections, two-hand operating of machines (e.g. for pressing and punching), safer cranes including 
better technologies for communication between co-workers, coverage of moving parts, safer company 
cars (e.g. safety belts and airbags), safer tools (e.g. for drilling or cutting); improved personal protective 
equipment like air-supplied breathing apparatus, steel mesh gloves for meat workers, trousers for forest 
workers that resist a chainsaw; minimum safety requirements for buildings (e.g. forms and size of stairs 
and handrails, fire exits and fire alarms, safer ladders and scaffolds), emergency equipment like eye 
wash  and  emergency  showers;  better  monitoring  of  acute  hazards  (e.g.  in  sewage  water  systems), 
exhaust  and  ventilation  technologies  to  avoid  fumes,  dusts,  chemicals  or  contact  with  hazardous 
biological agents; strong safety obligations for work in confined spaces, or for work at height and work 
in  trenches;  introduction  of  explosion  zones  and  of  non-sparking  tools,  a  comprehensive  system  of 
warning signals, warning signals for slippery floors and unsafe grounds, better warning systems and 
equipment in particularly dangerous work environments like road maintenance, combined with better 
organisational  measures;  quality  systems  that  promote  continuous  repair  and  maintenance  of  tools; 
regular instructions by safety representatives and safety coordinators, and guarantee of minimum safety 
standards of machines and products by European standards like CE (‘European Conformity’).  

Major technological developments 

The  widespread  introduction  of  new  or  advanced  technologies  —  automation,  digitalisation/ICT, 
green  technologies,  new  material  technologies  and  so  on  —  results  in  substantial  changes  in  work 
organisation and work processes, and replacement of (traditional) materials (screws by glues, metal and 
wood  by plastics, nanomaterials). For OSH regulators and  practitioners, it  is a constant challenge to 
assess these changes regarding their impact on risks for health and safety and to develop adequate 
risk prevention and mitigation measures.  

Foresight studies (e.g. by EU-OSHA) have shown that such technological change can help improve 
working  conditions,  for  example,  by  taking  over  heavy,  dangerous  or  routine  work  (automation, 
robotisation, exoskeletons), or by better communication and remote control via ICT tools. At the same 
time, they can also pose new risks, creating rigid work processes without much decision latitude, along 
with technical options for extreme surveillance and control (e.g. by constant geolocation), or pose new 
safety risks like working at height (renewable energies) or by exposure to materials with widely unknown 
health effects (e.g. nano). 

EU-OSHA has published several foresight studies to emphasise possible safety and health concerns. 
Examples are the reports and fact sheets about new safety risks in green jobs (green buildings, solar 
energy, wind energy) published more than 10 years ago. Since 2015, EU-OSHA has been publishing 
reviews  and  discussion  papers  on  emerging  risks  and  foresight  topics.  This  work  covers  topics  like 
robotics, performance-enhancing drugs, 3D printing, monitoring technologies, developments in the e-
retail sector, artificial intelligence, platform work, Long COVID, exoskeletons and so on. In 2018, the 
Agency published a foresight report on new and emerging OSH risks associated with digitalisation.  

A well-known example of such changes in work processes causing new OSH challenges is the growing 
number  of  workers  outside  the  premises  of  the  employer,  that  is,  at  non-stationary  or  mobile 
workplaces  or  at  home.  This  refers  to  the  increasing  amount  of  mobile  work  in  transport,  traffic  and 

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distribution and the increased number of workers doing their job in private homes (home care, domestic 
work, etc.), plus the rapid spread of remote office work in 2020 due to the COVID-19 pandemic. One 
major difficulty for risk prevention is to determine how far safety and health at these workplaces might 
deviate from the OSH requirements of a conventional workplace in an office building or an industrial 
plant, regarding topics like ergonomic and safe equipment, space, ventilation, daylight, electrical and 
fire safety, emergency procedures and so on.  

Globalisation 

Over the last decades, production and services have become less and less solely based on national  
(pre-)products or service suppliers and instead on international supply chains. Digitalisation facilitates 
the  globalisation  of  services  that  do  not  require  personal  presence.  International  supply  chains 
require logistics connections between countries and continents, harmonised technical standards, and, 
as far as possible, common legal rules, standards and agreements, be they for services or materials 
and products. The development of such supply chains divides the necessary work related to a product 
or a service in parts, which might also mean that OSH risks might not be shared in a fair or equal 
way.  

In industry, a relevant part of outsourcing to less-developed countries took place in sectors with high 
OSH risks: mining, metallurgic processes, treatment of hazardous waste, basic chemicals and textiles. 
At the same time, EU enterprises ‘import’ risks by producing goods for export (e.g. vehicles, machines, 
food, specialty chemicals). A full assessment of the division of OSH risks would require a case-by-case 
description.  

When looking at the work of global institutions during the past two to three decades, many important 
agreements,  conventions,  government  actions  and  global  business  programmes  have  been 
negotiated, agreed and  issued. The  objectives and necessary measures at a global level have been 
made much more concrete by these efforts. OSH and working conditions are on the agenda of these 
organisations,  and  general  and  concrete  targets  and  indicators  have  been  set.  The  task  is  the 
implementation of these principles and programmes in every region and country of the world in a 
way that it reaches all workplaces.  

Consequences of the COVID-19 pandemic 

The outbreak of the COVID-19 pandemic in 2020 required exceptional measures and quick reactions 
on many unanticipated challenges for OSH. The infrastructures — staff, material, measures — were to 
a large extent not available or prepared to cope with an acute pandemic of that size. EU-OSHA reacted 
with several guidance documents for employers and workers, that is, the ‘COVID-19: Guidance for the 
workplace’ and the guidance ‘COVID-19: Back to the workplace - Adapting workplaces and protecting 
workers’. 

In the EU OSH Strategic Framework 2021 to 2027, the impact of a pandemic or similar threat was 
addressed by one overall objective, namely ‘Increasing preparedness – responding rapidly to threats’. 
The strategy aims at employing the preventive experience gathered during the pandemic to prepare for 
potential future similar threats. Enterprises, sector organisations and health institutions have developed 
proven  workplace  and  sector-specific  risk  assessments  and  prevention  measures;  there  is 
experience with test procedures and timelines for quarantine and return-to-work and use of personal 
protective equipment. A major indirect impact on working conditions is the strongly increased share of 
remote work from home.  

In this policy area, important decisions have been made that are relevant for potential future pandemics 
of a similar kind, for example, the definition of essential work that needs to be continued despite a 
high infection risk, and safety and hygiene measures for work in education, care or public transport.  

Legal and regulatory frameworks 

OSH  is  a  shared  EU  and  national  responsibility.  Over  the  last  35  years,  the  EU  developed  a 
comprehensive  legal  framework  that  covers  and  regulates  OSH  risks.  It  changed  the  focus  from 
prescription of obligatory prevention measures for certain predominantly safety risks towards a general 
preventive and participative approach. That is, all OSH risks have to be assessed, consultation between 
employers and workers is required, and OSH training, expertise and preventive capacities are required 
for every enterprise. All EU OSH directives have to be transposed into national law. In parallel, national, 

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regional and local legislation and policies concretise the minimum conditions set by EU law and adapt 
to the risks in the specific context.  

New directives or revisions and updates of directives were introduced for several reasons, that is, 
coverage  of  new  technologies  like  artificial  optical  radiation  (use  of  laser,  etc.);  after  2017,  the 
Carcinogens  and  mutagens  directive  was  amended  several  times  towards  the  current  status 
(Carcinogens,  mutagens  or  reprotoxic  substances  directive).  The  revision  of  the  Display  screen 
equipment and workplaces directive — mainly to adapt it to the significant technological developments 
since their introduction — is one of the actions under the EU OSH Strategic Framework 2021 to 2027. 
In light of the changes of working conditions towards physical inactivity and repetitive work and the 
higher psychosocial and emotional demands, there have been calls from many stakeholders and 
experts for a stronger legal framework.  

Although the EU OSH legislation guarantees a strong legislative frame, evaluations of the practical 
implementation  at  workplaces  observe  certain  difficulties  in  implementation  (see  DG  EMPL 
evaluations  of  the  OSH  Acquis  or  EU-OSHA  reports  in  the  frame  of  its  research  on  supporting 
compliance).  Studies  and  evaluations  found  that  full  compliance  might  be  challenging  for  micro  and 
small  companies  (EU-OSHA  has  published  several  reports  on  safety  and  health  in  micro  and  small 
enterprises  (MSEs)).  It  also  seems  not  to  be  standard  practice  to  apply  the  hierarchy  of  preventive 
measures, that is, technical and organisational solutions of risk reduction first, and individual solutions 
as  a  last  resort.  As  mentioned,  it  is  also  a  challenge  to  swiftly  cope  with  technological  changes  and 
developments. 

Moreover, there are difficulties to apply the same level of protection to types of work with weakened or 
non-existing  employer–worker relations, for example,  temporary and subcontracted work, involuntary 
self-employed, seasonal work, platform work, domestic work and all types of irregular work. These forms 
of work often have as one major characteristic a less clear employer–worker relationship, while the 
main structural element of the EU OSH legislation is the dual role of employers and workers in OSH.  

OSH infrastructures 

There  exists  a  diverse  and  rich  OSH  infrastructure  in  most  EU  Member  States,  that  is,  labour 
inspection  and  other  supervising  authorities,  governmental  OSH  institutes,  prevention  and  research 
centres, knowledge centres, OSH training and education centres, and occupational health clinics. The 
social partners and professional organisations often contribute to this infrastructure, either in an advisory 
way or even as an integral part of such institutions. These institutions are responsible for supervision 
and  control  of  compliance,  they  train  OSH  practitioners,  produce  guidance  material,  engage  in 
improvement actions and projects, and contribute to more awareness and better knowledge. In many 
cases they help in adapting general legislation to sector- or workplace-specific regulations.  

EU Member States apply very diverse regulations regarding the number and required qualification 
of OSH staff in enterprises, and for external protective and preventive services (PPS). In diverse 
ways, the Member States prescribe topics like necessary qualifications and certificates, depending on 
sector and work tasks, time granted for preventive work and training, and obligatory or voluntary use of 
external PPS by enterprises, while some of these PPS offer technical support and others also medical 
monitoring and advice. In some countries such support is granted for free in certain sectors or for certain 
types  of  enterprises.  The  role  and  power  of  all  actors  in  these  systems  varies  substantially,  defining 
such roles specifically for employers, workers’ representatives and safety representatives.  

During the last two decades, nearly all EU Member States have developed strategic approaches, mostly 
called ‘National OSH Strategies’ or ‘National OSH Plans’. In most cases, these strategies have helped 
to identify and mitigate recognised structural weaknesses of the national OSH system, for example, low 
levels  of  implementation  of  existing  legislation,  insufficient  reporting  and  monitoring  tools,  or  specific 
sector  or  risk-related  actions,  and  finally  also  regulatory  improvements.  The  EU  OSH  strategies  and 
OSH strategic frameworks have often been used as orientation for objectives and actions of national 
strategies; the first started in 2002 (‘Communication from the Commission - Adapting to change in work 
and  society:  a  new  Community  strategy  on  health  and  safety  at  work  2002-2006’).  The  latest  EU 
Strategic Framework on Health and Safety at Work 2021-2027 puts the focus on changes; it is titled 
‘Occupational safety and health in a changing world of work’ and focuses on three key objectives for the 
coming  years:  (1)  anticipating  and  managing  change  in  the  new  world  of  work  brought  about  by  the 

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green,  digital  and  demographic  transitions;  (2)  improving  prevention  of  workplace  accidents  and 
illnesses; and (3) increasing preparedness for any potential future health crises. 

Where did improvements take place? 

Improvements took place  in major areas: legislation,  guidance,  instruction, development  and  use of 
OSH supporting analogue and digital tools, training of OHS practitioners and professionals, application 
of OSH management systems, organisational progress in many areas like safety coordination, higher 
awareness about several topics and aspects like specific risks for certain groups, psychosocial risks and 
mental health, technical improvements, better technologies to reduce physical health risks like noise or 
dust,  less  exposure  to  and  use  of  highly  hazardous  chemicals,  better  medical  treatment,  financial 
incentives, and safety and health obligations from insurers.  

In public and policy, the main indicator for safety outcomes remains the work accident figure, that 
is,  fatal  and  non-fatal  accidents  at  work  and  traffic  accidents  in  connection  with  work  or  during 
commuting. The overall statistical picture shows a strong decrease since the mid-1990s until 2010; this 
positive development continued after 2010 but with significantly lower reduction rates. The main cause 
of this decrease is better organisational and technical prevention, and it is also supported by economic 
developments like sectoral shifts — for example, decrease of workforce in high-risk sectors like mining 
and agriculture —, and technological changes.  

When looking at recognised occupational diseases — not work-related diseases — as an indicator for 
health outcomes of working conditions, these underwent a similar decrease to that for work accidents. 
The outcomes for the main occupational disease groups descended, for example, hearing impairments 
from  noise  at  work,  pulmonary  diseases  (from  exposure  to  dust  and  chemicals),  very  specific 
musculoskeletal diseases, and diseases related to exposure to hazardous biological or chemical agents. 
However, the latest estimates of the burden of diseases from the WHO/ILO and ICOH do not show a 
decline  in work-related  diseases. The figures might even considerably increase  in future estimates if 
mental diseases and illnesses from biological agents are incorporated.  

Coping with a broader variety of the workforce — higher age, higher skills and longer education, more 
women and more international workers — is a challenge for OSH practices in enterprises. It is a topic 
that  is  tackled  in  a  large  and  increasing  number  of  preventive  information  and  guidance  documents. 
Preventive services, external or internal, in a private, state or mixed framework, are functioning 
as  an  important  pillar  of  OSH;  they  are  crucial  for  the  implementation  of  good  and  best  practices  in 
enterprises.  

We  can  observe  more  global  efforts  for  better  OSH.  Ethical  considerations  in  supply  chains  are  of 
increasing  importance  for  enterprises  in  international  trade  and  many  markets.  International 
organisations like the ILO, WHO, ISSA, UN, ICOH and IALI continue to develop not only objectives and 
observation tools but also more and more action programmes to practically improve the situation globally.  

The modernisation of the EU OSH legislation from the middle of the 1980s onwards has created a 
critical frame for prevention of OSH risks. The EU, Member States, governments and social partners 
have  agreed  on  this  legislation  and  the  Member  States  have  transposed  them  into  their  national 
legislation. The overall legislative framework  is generally complete  and comprehensive. Moreover, 
the  European  Commission  launched  an  initiative  to  agree  on  the  ‘European  pillar  of  social  rights’ 
comprising 20 guiding principles for the work of the EU institutions in the field of social policy. In 2017, 
the Pillar was agreed by the Member States; in particular principle 10 refers to a healthy, safe and 
well-adapted work environment. 

Where do we find stagnation and ambiguous developments? 

Stagnation  can  also  be  observed  in  important  areas.  Since  2005,  the  share  of  workers  exposed  to 
traditional safety and health risks — accidents, noise, vibrations, dust, chemical and biological agents, 
high or low temperatures, electrical shock and so on — remains at a stable level. Even some increase 
can be observed due to a higher share of workforce in sectors with such risks, like transport, logistics 
and distribution, renovation and maintenance, green technologies, and health and care. The national 
regulations for these risk areas are generally well developed and detailed; a mixture of overall goals and 
prescriptive details is the major approach. An increasing and difficult challenge will be to keep sufficient 
safety and health standards for new forms of work and for mobile work, work from home and work at 

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clients’ places. Also ergonomic risks — repetitive hand-arm movements, tiring and painful positions, 
lifting  and  carrying,  and  prolonged  sitting  —  can  pose  major  health  risks,  and  the  statistics  show  no 
significant decrease.  

There is a shift of workforce to administrative, communicative, and emotionally demanding and 
client-oriented sectors, like the sectors ‘Education, human health and social work activities’ and ‘Trade, 
transport, food/accommodation and recreation activities’ (more human–human interaction, less human–
machine interaction). Consequently, this development caused an overall shift of risks to psychosocial 
and emotional challenges and — mostly but by far not always — less physical activity. Some health 
risks worsen in such types of work, like work with difficult clients or long working hours. Many approaches 
and pilot projects have been developed to mitigate these workloads, but the implementation seems to 
be limited to a minority of workplaces with high awareness of work-related health issues. Also, since 
2005, statistics and surveys find a stagnation (practically no increase and no decrease) concerning the 
development of working time, time pressure and high workload for workers.  

When  looking  at  the  overall  relationship  between  work  and  some  major  diseases  in  the  adult 
population (cardiovascular diseases, cancer, musculoskeletal disorders, pulmonary diseases, hearing 
loss), there is a clear connection to socioeconomic status that is a major cause of low life expectancy 
and high morbidity. In public health morbidity and mortality studies, a more precise analysis of impact 
of working conditions on health, as a very important factor of socioeconomic status, is very rare. This 
would  require  more  detailed  knowledge  and  analysis  of  the  health  impacts  of  occupations  and  work 
tasks and of the preventive measures at work, as well as an improvement in the detection capacities of 
preventive  and  monitoring  health  systems.  Identification  of  the  approximate  attributable  fraction  of 
work to diseases is still the subject of intense scientific debate, with clearer results for some relations 
and less clear results for others. 

The level of implementation and enforcement of compliance with legislation seems to stagnate. The 
capacities  of  the  OSH  infrastructure  at  national  levels  show  a  mixed  picture  in  EU  Member  States. 
Across the EU, between 2010 and 2020, the labour inspectorates performed on average two million 
labour  inspections  per  year,  in  approximately  22  million  businesses.  To  enhance  the  level  of 
implementation  in  terms  of  coverage  and  quality,  many  labour  inspections  tried  to  enhance  the 
effectiveness  of  common  drop-in  company  inspections  by  smart  enforcement  and  supervision 
concepts.  

There  is  no  measurable  progress  in  the  types  of  work  with  eroded  employer–worker  relations 
(subcontracts,  involuntary  self-employed).  The  reliability  of  statistical  monitoring  fades  where  the 
employer–worker  relationship  is  less  clear  (regarding  aspects  such  as  working  conditions,  work 
accidents and work-related diseases, and of compliance with legislation).  

Many enterprises and particularly MSEs and the self-employed very often cannot fully comply with 
more complex risk prevention tasks (e.g. psychosocial, chemical, biological, optical, electromagnetic 
risks)  due  to  lack  of  resources,  expertise  and  awareness  (ESENER  data).  In  general,  enforcement 
authorities can only supervise a small percentage of enterprises, particularly not a substantial portion of 
MSEs,  of  self-employed  or  of  non-standard  types  of  work;  some  Member  States  included  in  their 
strategic  approaches  the  objective  to  reach  these  enterprises/self-employed.  The  reason  for  the 
continued  levels  of  intensification  of  work  from  2005  onwards  might  be  that  the  related  tasks  were 
contracted out or put on the shoulders of non-standard workers, for example, self-employed, temporary 
and seasonal workers.  

Some EU OSH legislation may be adapted and modernised to cope with the changes in technologies, 
employment conditions, longer working life, and a growing share of mobile and remote work. Many of 
these changes in the world of work have caused higher insecurity, less clear employer–worker relations, 
and a higher burden of psychosocial and ergonomic risks.  

Which are the areas of concern? 

Incomplete compliance with OSH regulation is more noticeable in certain sectors and types of work. 
Most of these types of work — mobile and home-based work, domestic work, care work and long-term 
domestic care work, seasonal work, platform work, non-voluntary self-employed — are growing in terms 
of workforce. But many of these work and employment formats are until now not covered in the same 

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way by OSH legislation or OSH practice. The principle of employer responsibility for working conditions 
of workers is undermined or at least blurred in such situations.  

Future solutions could focus on several aspects — a new definition of ‘work’ or of ‘employment’, 
stronger individual responsibility, or extended state interventions to guarantee OSH also in such 
working and employment conditions. There are some examples of such solutions but to date most of 
them focus on better information, that is, stronger individual responsibility.  

Undeclared and illegal employment is scarcely visible in the statistics. Due to the difficult conditions 
for research, the overall OSH situation in these types of work is widely unknown; in case study-based 
investigative studies, the working conditions — including safety and health — for this group are mostly 
regarded  as  worse  compared  to  workers  with  a  regular  work  contract.  It  seems  to  be  necessary  to 
consider different research and action initiatives for this type of work, also in collaboration with other 
state supervising authorities.  

The health data clearly show an ever-growing share of work tasks that go along with or even require 
physical  inactivity.  Inactive  work  is  often  characterised  by  permanent  sitting  combined  with  high 
requirements for visual and mental focusing during work, for example, towards digital equipment or to 
traffic  situations.  Serious  indirect  health  consequences  of  such  inactivity  can  be  seen  in  the  strong 
increase in certain widespread diseases or disease-supporting factors, like obesity.  

Even  15  years  after  the  enlargement  of  the  EU  in  2004,  significant  differences  between  Member 
States can still be observed regarding several working conditions. The data demonstrate that the worst 
status concerning physical risks, wellbeing, and expectations to do the job until the age of 60 — is almost 
always present in eastern EU Member States, followed by southern Member States, all compared to the 
status in central, western and northern Member States. For psychosocial risks, it is just the other way 
around, these are more often reported in central, western and northern Member States.  

International organisations complain about an unfair divide of OSH risks in globalised supply 
chains, be it in mining, metallurgy, textile production, disposal of hazardous waste or other sectors. The 
ILO decided in June 2022 to make OSH one of the Fundamental Principles and Rights at Work. In this 
context, 10 ILO conventions and instruments are considered now as fundamental, including two OSH 
conventions: the Occupational Safety and Health Convention, of 1981 (No. 155) and the Promotional 
Framework  for  Occupational  Safety  and  Health  Convention,  of  2006  (No.  187).  Ethical,  fairness  and 
justice  considerations  have  led  to  more  activities  on  decent,  safe  and  healthy  work  in  developing 
countries and a fair share of risks at work in global supply chains. These are important initiatives, but 
until now they only slightly changed the overall situation when looking at the global scale of the issue. 

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2  Setting the scene 

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The ethical and economic importance of safe and healthy working conditions was the root cause for the 
development of a strong legal framework and comprehensive policy actions targeting EU workplaces. 
The objective of all related measures is to reduce the avoidable burden for individuals and society, that 
is annually more than 3,000 fatal accidents at work, and more than 230,000 severe accidents at work, 
and an estimated 180,000 deaths from work-related illness. 

During the last 50 years, we have witnessed significant progress in the field of OSH in EU Member 
States. Milestones along the way provide evidence that a preventive, proactive and often participative 
approach has become mainstream in policies and many businesses. The number of work accidents that 
Eurostat registers has decreased significantly in the period between 1994 and 2020. The EU stabilised 
and promoted this development, particularly in the 1990s, by adopting the overarching OSH Framework 
Directive and 24 specific OSH directives. OSH strategies and strategic frameworks at EU and Member 
State  levels  have  contributed  to  streamlined  approaches  in  priority  areas.  Higher  safety  and  health 
standards, better preventive technologies and OSH management, improved training and education of 
OSH  professionals,  and  scientific,  technical  and  medical  progress  have  contributed  considerably  to 
improving safety and health at work. Member States, the EU and international organisations have been 
providing comprehensive and manifold guidance and support for enterprises, covering virtually every 
kind of OSH-related issue and proposing practical preventive measures. Broad and extensive research 
at  national  institutes  and  universities  and  by  EU  institutions  has  considerably  improved  the  level  of 
evidence and knowledge on OSH.  

Looking at the challenging and weaker aspects of the last 30 years, we still observe deficits concerning 
the level of compliance and enforcement of OSH legislation, particularly in some sectors, types of work 
(e.g.  mobile  or  domestic  work),  types  of  enterprises  (e.g.,  micro  and  small  enterprises),  and  in  less 
secure and irregular forms of work. During the COVID-19 pandemic in 2020 and 2021, quite a few media 
reported on insufficient safety and health measures in irregular, informal, insecure and illegal forms of 
work,  for  example,  in  several  types  of  seasonal  or  subcontracted  work.  Permanent  and  seemingly 
accelerating changes in economic and social policies, technologies and forms of work, the demographic 

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composition of the workforce and the climate influence on working conditions challenge all stakeholders 
in the field of OSH to keep pace with all these developments. In addition, the EU and consequently also 
OSH in the EU is increasingly and significantly influenced by the globalisation of product and service 
chains and the internationalisation of its workforce.  

This report is a common effort of EU-OSHA and major stakeholders. It is a product of EU-OSHA’s activity 
‘EU OSH Info system’ and aims at interpreting and analysing the quantitative and qualitative data on 
OSH in the EU that have been collected during the past six years in this activity. The purpose of this 
report  is  to  summarise  status,  trends  and  key  aspects,  preferably  based  on  statistics,  data  and 
related analytical research findings.  

The idea of a permanent observation or monitoring of the situation of working conditions and OSH is not 
new. In the past three EU OSH strategies between 2002 and 2020, it was always an objective to improve 
the  knowledge  on  working  conditions  and  OSH  and  by  doing  that  to  facilitate  better  evidence  for 
stakeholders and give them a solid base for their activities and prioritisation. 

The idea of better monitoring was strengthened by DG EMPL in 2015 in a broad and systematic effort 
to develop a new EU OSH Info system, based on indicators. The development and design of such a 
system was done in collaboration between DG EMPL, EU-OSHA, newly established National Contact 
Points,  and  the  Advisory  Committee  on  Safety  and  Health.  Many  indicators  were  discussed  and 
subsequently included or discarded, depending on their relevance but also depending on the availability 
of reliable data and the efforts needed to collect such data. For example, a good description of working 
conditions  based  on  EU-wide  surveys  or  statistical  data  is  available,  whilst  a  detailed  description  of 
national prevention systems would require considerable research efforts and is until now not part of this 
info system. In 2023, the info system provides more than 125 datasets for 16 major indicators.  

All these data are presented online in a visualised mode, the OSH Barometer 1. This data visualisation 
tool does not create new data but combines major OSH-related and publicly available quantitative 
data with qualitative descriptions and analysis. Many of the indicators and data collections that are used 
in this report are  published in the OSH  Barometer. All quantitative  indicators  are based on available 
data, that is, they are not based on new research but on existing sources. These sources are dispersed, 
the info system brings it all together and makes access and overview significantly easier.  

Many of the key findings of this report are based on previous work conducted by EU-OSHA; many 
of  these  data  and  research  results  show  obvious  and  (nearly)  unambiguously  accepted  findings. 
Sometimes  the  existing  data  and  findings  are  weak  and  ambiguous  and  allow  quite  diverging 
interpretations of the reasons and reality behind such data. For these areas and topics, even a combined 
analyses of quite different sources can only present hypotheses and no clear evidence; in these cases, 
the  current  knowledge  is  not  more  than  a  starting  point  to  clarify  open  questions  and  to  undertake 
research, data collection and data analysis efforts. 

This report aims at contributing to better evidence as a base for more effective and comprehensive 
actions.  A  precise  picture  can  better  inform  priority  choices  to  be  made  by  the  legislators  and  state 
institutions, by enterprises, workers and their associations, and by OSH professionals. It can result in 
the ultimately desired effective protection of all groups of workers, in all sectors, all occupations, all work 
tasks and all forms of work. 

This report paints a mostly quantitative picture of the current OSH status in the EU. It uses data from 
European  surveys  and  statistics  that  were  compiled  in  the  frame  of  EU-OSHA’s  activity  ‘EU  OSH 
Information System’ and combines quantitative data with explanatory and analytical descriptions. The 
report covers trends that reach back between 10 and 25 years — depending on data availability and 
methodological issues. It also takes into account relevant context factors, be it economy, workforce and 
demography, industrial relations or technological developments.  

The report covers as many indicators, trends and context developments as possible. Short overviews 
and summaries form the character and shape of this report, not detailed descriptions. This is slightly 
compensated by extensive referencing to literature, particularly the OSH Barometer data visualisation 
tool,  reports  by  EU-OSHA  and  other  EU  agencies  (e.g.  Eurofound),  and  other  EU  institutions  and 
international agencies.  

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The  analytical  distinctions  were  mostly  made  according  to  work  and  workplace-related  criteria,  like 
occupation, type of work, different contractual conditions and, in some cases, emphasising differences 
between EU Member States; it presents fewer data on characteristics of different worker groups, like 
age, sex and origin.  

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3  Status of working conditions 
This  chapter  on  health  and  safety-related  working  conditions  provides  an  overview  on  status  and 
development of working conditions; it is mainly based on the indicators that were selected for the data 
visualisation in the OSH Barometer. This is a quite limited selection of major data; in surveys and 
statistics many more indicators on working conditions are provided, particularly at national level.  

Practically all working conditions influence mental health, that is, they involve psychosocial risks, and 
all  also  involve  ‘physical  risks’,  including  safety  aspects  of  these  risks.  Mental  health  risks  are 
illustrated in the OSH Barometer by datasets on time pressure, poor communication, dealing with difficult 
clients,  discrimination  and  harassment,  and  similar.  Physical  risks  include  datasets  on  accidents  at 
work,  exposures  to  chemical  and  biological  substances,  exposure  to  noise,  vibrations,  high  or  low 
temperatures, and working tasks with ergonomic risks, like carrying, lifting heavy loads or work in tiring 
or painful positions; and also permanent physical inactivity, mainly sitting or long standing. 2  

The figure below shows the percentage of enterprises reporting OSH risks ‘present in the establishment’, 
compared between 2014 and 2019 (ESENER) and covering mental and physical risks.3  

Figure 1: Risk factors present (% of establishments) – ESENER 2014 and 2019 

Note: Prolonged sitting was a new item in the 2019 survey. 

Between 2014 and 2019, some risk factors increased, like ‘Repetitive hand and arm movements’, ‘Lifting 
or moving people of heavy loads’, and ‘Having to deal with difficult customer, patient and pupils; many 
others showed no changes, like ‘Risk of accidents with machines or hand tools’, ‘Chemical or biological 
substances’, and ‘Loud noise’, or minor decreases like ‘Risk of accidents with vehicles’. 

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3.1  Psychosocial risks at work 
During the last 30 years, the scientific, political and practical discussions on psychosocial risks and 
preventive measures against psychosocial risks have gained strong importance. After a period of doubts 
and resistance, today they are regarded as risks of the same severity as the classical physical safety 
and health risks.4 (Chapter 1 covers the psychosocial risk aspect; for the prevalence of mental diseases 
and the burden of mental diseases see Chapter 2.2. 5) 

Looking at the steady increase of certain psychosocial risk indicators at workplace level, either the risks 
have increased and/or the number of people working in occupations with higher psychosocial risks 
has  increased.6,7 This  is  valid,  for  example,  for  the  indicator  time  pressure,  for  example,  in  delivery 
services, transport, and often also clerical work; the workforce has grown in sectors where emotional 
demands from dealing with difficult clients, customers, pupils or patients are common; there are also 
more workers employed (or self-employed) in interactional occupations, for example, in call centres, or 
in occupations with a high level of emotional tensions, for example, education, health and care. 

Figure 2: Risk factors that can adversely affect mental wellbeing – EWCS8  and ESENER9 

A major difference between the ESENER and the EWCS survey is the respondent. In ESENER those 
persons who are most familiar with OSH or responsible for OSH in an enterprise were asked whether a 
certain risk factor exists in the enterprise; in the EWCS survey workers themselves were asked whether 
they are exposed to a risk factor. 

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In 2007, 2013 and 2020, Eurostat asked employed persons in its ad hoc surveys to the Labour Force 
Survey (LFS) whether they had ‘… exposure to risk factors that can adversely affect mental well-
being’.10 In  2007  and  2013,  the  questions  covered  four  items  (time  pressure  and  overload  of  work, 
violence  or  threat  of  violence,  harassment  and  bullying,  other  factors).  In  the  2020  survey,11 ‘Mental 
well-being’  was  operationalised  by  an  additional  four  response  options,  resulting  in  a  total  of  eight 
options:12  

1.  Severe time pressure or overload of work;  
2.  Violence or threat of violence;  
3.  Harassment or bullying;  
4.  Poor communication or cooperation within the organisation;  
5.  Having to deal with difficult customers, patients, pupils etc.;  
6.  Job insecurity;  
7.  Lack of autonomy, or lack of influence over the work pace or work processes; and  
8.  Another significant risk factor for mental well-being.  

Forty-five per cent of the employed persons reported being exposed to risk factors that can adversely 
affect mental wellbeing. The country data vary significantly. Sweden, Greece and Luxembourg report 
over two-thirds such exposures, and Germany, Lithuania and Czechia one-third or less.13 

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Figure 3: ‘Exposure to risk factors adversely affecting mental wellbeing’ – LFS Ad hoc survey 202014 

ESENER 2019 reveals that several psychosocial risk factors are reported to be present in a significant 
share of establishments in the EU27, namely having to deal with difficult customers, patients and pupils 
(59%) and time pressure (45%).  

The aspects ‘Difficult clients’, ‘Poor communication’ and ‘Long working hours’ are major psycho-
social risks. The increase of workforce in communicative and client-oriented occupations — social work, 
education,  tourism  and  entertainment,  health  and  care  —  during  the  last  30  years  adds  to  the 
conventional work with clients in service, sales and health occupations.  

The  next  table  shows  the  top  seven  EU  Member  states  with  the  highest  share  of  these  risks  for  all 
sectors and for the sector ‘Human health and social work activities’ (HHSW).  

Table 1:  Psychosocial  risks,  Top  countries  ‘All  Sectors’  and  ‘Human  health  and social work’ –  ESENER 
2019 

Difficult  customers,  patients  and  pupils  (‘clients’)  seem  to  be  the  most  widespread  psychosocial 
burden, with workers in Portugal, Malta and Cyprus are most exposed. In the sector HHSW, eastern 
European countries are much more present, Slovenia at the top, followed by Portugal, Estonia, Poland 
and Bulgaria. 

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Concerning the complaints about poor communication and cooperation within the organisation, all 
three Nordic EU Member States are represented in the seven countries with the highest burden, together 
with  several  central  European  countries.  This  is  valid  for  both  selected  groupings,  ‘All  sectors’  and 
‘HHSW’. 

Regarding long or irregular working hours, we see a mix of countries from all regions. The order of 
countries in the sector HHSW — a mixture of countries from the East, South and North — is probably 
due to specific sectoral regulations of working times. Sweden is at the top in HHSW with 57%, followed 
by Denmark, Cyprus, Latvia and Czechia, all between 44% and 48%.  

Many analyses of psychosocial risks include other relevant factors like decision latitude (or decision 
authority) and skill discretion (level of skill and creativity required on the job). In a long-term analysis 
of the responses to the EWCS between 1995 and 2015, the authors conclude:15 

‘Our findings suggest that work stress generally increased from 1995 to 2015, and that the increase was 
mostly driven by psychological demands. People working in lower-skilled occupations had generally higher 
levels of job strain and effort-reward imbalance, as well as they tend to have a steeper increase in job 
strain than people working in higher-skilled occupations. Most of the change occurred from 1995 to 2005.’  

According to this study, the differences between the skills groups are significant, below illustrated for 
the development of ‘Psychological demands’ and ‘Job strain’; for these two indicators high-skilled 
and low-skilled manual workers are at the top of the scale. 

Figure 4: Psychosocial risk factors – Differences between skill groups (Job strain) 

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Figure 5: Psychosocial risk factors – Differences between skill groups (Psychological demand) 

Regarding  the  other  two  analysed  indicators,  decision  authority  and  skill  discretion,  the  clerical 
workers show higher levels (a positive outcome) and both manual worker groups are at the lowest level.  

Figure 6: Psychosocial risk factors – Differences between skill groups (Decision authority) 

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Figure 7: Psychosocial risk factors – Differences between skill groups (Skill discretion) 

For ‘Decision authority’ and ‘Skill discretion’, the authors found a stable situation since 1995, even a 
small rise of skill discretion for manual workers after 2010. Regarding ‘Psychological demands’ and ‘Job 
strain’, the major increase for all groups took place between 1995 and 2005. This growth decelerated 
after 2005, this observation is also valid for other working conditions, like work intensity. 

3.1.1  Working time in hours and at atypical times  

Too many hours of working time and/or working hours at atypical or unsocial times can put the 
mental and the physical health of humans at risk. It is also regarded as a major contributing factor 
to work accidents, due to fatigue or exhaustion.16  

The main indicator to describe working time is the number of the weekly average working hours of 
full-time employees. However, regarding its  impact  on health and safety, other  aspects of working 
time are of the same relevance: 

•  How long is the average working day? 
•  At which times and days is this work done (typical, atypical times)? 
•  How often do long working hours take place? 
• 
•  How flexible are start and end? 
•  How intense is the work during this time (breaks, deadlines)?  
•  Which groups of workers have standard working times and which do not (e.g. depending on the 

Is the work split between two jobs? 

sector or the type of contract, e.g. sub-contracted workers or self-employed)? 

There is a slight trend towards fewer working hours for full-time employees (not ‘Employed persons’) 
in the EU27; between 2006 and 2019 the average weekly working time dropped from 40.2 to 39.9 hours, 
a decrease of approximately 15 minutes.17 

Regarding the weekly hours, there are no striking differences between the EU27 Member States. In 
2019, Cyprus, Austria and Malta with a high share of workers in the sector of tourism (accommodation) 
had the highest number of working hours per week (above 41 hours), and Denmark, the Netherlands 
and Italy the lowest number (39 or fewer) (full-time, employees, 15-64 years, all NACE codes).18  

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‘Bakers are craftsmen, working mostly at night, unlike other craftsmen who, once 
their work during the day is done, can grasp sleep, and by this renew the worn-out 
forces. The bakers are the whole night rushing about, and then, for most of the day, 
they are forced to indulge in sleep, just like those animals hiding from the sun 
(Solifugae). Therefore, in the same city there are Antipodes, men who live a life that is 
contrary to that of others.’  
Ramazzini, 1713: De Morbis Artificum Diatriba. 

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Figure 8: Hours worked per week of full-time employment, EU27 – Eurostat 

The commuting time between home and workplace is quite stable; in 2005 at EU27 level, it stood at 
42.4  minutes,  and  in  2015  Eurostat  reports  40.2  minutes  (time  for  both  ways,  to  the  workplace  and 
back).19  

Work at atypical working times  is in  general regarded as a working condition  with  negative health 
impact, called work extensity. The two major indicators of atypical working times are work at ‘atypical 
working times’ and ‘long working hours’. 

Eurostat reports for ‘Employment at atypical working time’20 a minor decrease between 2011 and 
2019, from 38.8% to 37.2% (EU27), for all employed workforce and all types of such atypical time. 21 
Some groups of self-employed show a higher rate of atypical working times but also for most of the 
categories of self-employed the rates decreased during the period 2011 to 2019. High managerial self-
employed  had  a  slight  increase  from  42.1%  to  43.2%  in  this  period.  For  the  low  managerial  self-
employed  Eurostat  finds  a  decrease  from  69.2%  to  64.5%.  The  figures  for  small  entrepreneurs 
dropped slightly from 56.6% to 54.1%, the same applies for employed persons in personal care work 
with  a  minor  change  (50.6%  to  49.8%).  Agricultural  self-employed  had  the  highest  level  of  such 
working times; they showed a decrease from 68.4% to 63.4%. 

The length of the daily or weekly working time, its allocation over the 24 hours of a day or at night are 
important factors for health and wellbeing. The statistical data (Eurostat) show a slight decrease of the 
average weekly working time for full-time employees (15-64 years) from 40.2 to 39.9 hours between 
2006  and  2019.22 The  data  also  document  slight  increases  and  decreases  of  work  at  atypical  times 
(response option for frequency: ‘usual’).23 In 2006 and 2019, the following percentages of all employed 
persons worked at atypical times: on Saturdays the percentage decreased from 28% to 25%, working 
on Sundays remained stable at around 13.5%, working in the evenings decreased from 19% to 15%, 
work at night fell from 7% to 5% and shift work increased slightly from 17% to 18%.24  

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Figure 9: Average working time and work during unsocial hours – Eurostat LFS   

Two country examples might illustrate these developments (all data for 2019): Slovakia, a country with 
a high share of process-based industries, reports that 15.0% of its workforce is working at night and 29% 
in shifts; for the EU27 this rate is 5.2% respectively and 18.3%.25 Regarding work on Sundays three 
other countries are at the top of the EU27, the Netherlands, Ireland and Spain; they report between 18% 
and  21%  (EU27  average  =  13.5%);  all  three  countries  have  an  above-average  share  of  sectors  like 
transport, tourism and agriculture.26  

For  all  these  types  of  work  it  should  be  take  into  account  that  other  groups  of  workers  under  non-
standard  types  of  employment  contracts  (self-employed,  agency  workers,  students,  pensioners, 
undeclared workers) might have taken over work at these atypical working times.  

Concluding, it can be stated that there is a slight trend towards a reduction of weekly working hours 
for regularly employed workers, including a stable commuting time. Working hours at atypical times 
show a mixed picture. Looking at most types of employees, atypical working time decreased, except 
work on Sundays. For self-employed with employees, the working time at atypical hours is in general 
at a higher level. The number of employees in night work is decreasing. More employees in service and 
client-related occupations at night or in shifts but also here the atypical times are slightly decreasing.  

Probably  these  changes  mirror  the  structural  economic  changes,  that  is,  the  shift  of  workforce 
between sectors. Night work was common in many industries as part of a three 8-hours shifts, not only 
in industries with permanent production processes (steel, chemicals, etc.). 27 Moreover night work is and 
was  common  in  essential  services  like  health,  transport,  technical  infrastructure  and  security.  The 

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number of workers in industry decreased, but the number of workers in the above-mentioned service 
sectors increased.  

3.1.2  Work intensity  
There are numerous references showing that during the period between 1990 and 2005 work intensity 
has considerably increased.28  

For example, Eurofound has analysed the responses to the two EWCS questions on high speed at work 
and tight deadlines. The EWCS found a significant increase of work intensity between 1991 and 2005. 
In 1991, ‘Working at a very high speed’ was for the majority of respondents not an issue. Fifty-two per 
cent of the workers responded to this statement ‘Never’ or ‘Almost never’; in 1991, 24% worked at high 
speed and responded ‘Around ¾ of the time’, ‘Almost all of the time’ and ‘All of the time’; until 2005 this 
response rate went up by 11% to 35%. 

Working to tight deadlines was not an issue for 34% in 1990, and in 2005 only for 19%, a reduction 
of 15%. The percentage of the sum of responses ‘Around ¾ of the time’, ‘Almost all of the time’ or ‘All 
of the time’ to this question on tight deadlines increased between 1991 and 2005 from 29% to 37%. 
Regarding these two indicators, work intensity has evidently increased between 1991 and 2005. 29 

Figure 10: Development of work intensity indicators between 1991 and 2015 – Eurofound  

After that first period between 1991 and 2005, this development seems to stagnate between 2005 
and 2015.30 The responses ‘Almost all of the time’ or ‘All of the time’ vary only slightly, between 33% 
and 37% depending on year and question (‘Working at high speed’ or ‘Working to tight deadlines’). 

Differences can be seen regarding sector, company size and occupation. Regarding work intensity, 
ESENER enterprise data on time pressure for the EU27 indicate a slight increase of 2.3% between 2014 
and 2019 from 43% to 45%.31 Interestingly, according to ESENER, time pressure drastically increases 
with the size of the enterprise. In enterprises with 5 - 9 employees, 39% report time pressure, and in 
enterprises  with  above  250  employees  69%. 32  The  same  applies  for  long  working  hours,  where 
enterprises with 5 - 9 employees report 19% ‘long working hours’, and in enterprises with above 250 
employees this percentage increases to about 39% (EU27, 2019).33 

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Figure 11: Establishment size and ‘Pressure due to time constraints’ – ESENER 2014 and 201934  

Figure 12: Establishment size and ‘Long or irregular working hours’ – ESENER 2014 and 201935  

Sectoral  differences  are  also  strong  but  not  that  large  as  between  enterprise  sizes  they  vary  for 
‘Pressure  due  to  time  constraints’  between  32%  in  agriculture  to  54%  in  education  and  HHSW 
activities.  

Looking at countries, as indicated the figure below, the three Nordic EU Member States are at the top 
of the EU27 countries, all three with rates of more than 70%. The lowest levels of less than 30% are 
reported for Italy, Lithuania and Slovakia. 36 

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Figure 13: ‘Pressure due to time constraints’, Yes responses – ESENER 2019  

It has to be noted that ESENER responses refer to the situation in an enterprise, and the LFS and EWCS refer to 
the individual situation of a worker/employed person.  

Also in 2019, the Eurostat LFS Ad hoc module on working arrangement and working time shows quite 
similar data.37 Approximately 35% of all employed persons in the EU27 are working ‘Often’ or ‘Always’ 
under time pressure.  

Figure 14: Employed persons and percentage of working time under pressure – Eurostat LFS Ad hoc 2019  

The country-specific data from the LFS differ in many aspects from the ESENER data. Greece, Malta 
and Czechia are at the top, the Nordic countries in a middle position and at the lower end we find a 
mixture  of  countries  from  all  geographical  regions.  This  difference  is  probably  due  to  the  applied 

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methodology, the OSH practitioners who were asked in ESENER seem to have a different view on time 
pressure than the workers themselves who are respondents in the LFS. 

Figure 15: Percentage of employed persons with working time under pressure (per country, sum of 
responses ‘Always’ and ‘Often’) – LFS Ad hoc 2019  

One hypothesis to explain the increased time pressure is to draw a direct connection between short 
weekly working time and more intense work; or in other words, a short weekly working time leads to 
more intensification of work or more long hours or atypical working times (‘trading flexibility for 
effort’). 38  

The  analysis  of  EU  survey  data  shows  a  mixed  picture:  Firstly,  ESENER  data  corroborate  this 
hypothesis, the three countries with highest percentage of work under time constraints — that is, Finland, 
Sweden and Denmark — all have working hours under the EU average. Secondly, LFS data show a 
different picture; a country like Greece has the longest working hours and also reports the highest time 
pressure, the same ‘combination’ — but less extreme — applies to Austria, Cyprus and Malta. Trends 
of low or less than average working time and no time constraints are reported for Lithuania, and medium 
working time and low time constraints for Italy and Ireland.  

An analysis of EWCS data concluded39 that in general intensity increases with long working hours, in 
enterprises with 1-19 the work intensity index (on a scale between 0 and 12) is 4.4, in larger enterprises 
with above 40 employees it is 6.3. This is in line with ESENER data that corroborate the importance of 
the size of the enterprise for time pressure and long working hours.  

Literature  —  from  very  diverse  disciplines  —  on  work  intensification  points  to  reasons  for 
intensification on developments as:40 

•  Economic  developments,  particularly  the  dominance  of  neoliberalist  policies  and  enhanced 
competition  between  workers,  companies  and  states;  reduction  of  state  influence  and 
privatisation.41  

•  Pressure  due  to  substantial  organisational  changes,  for  example,  introduction  of  short-term 
economic  objectives  in  enterprise  policies, 42 expansion  into  new  markets  or  new  countries, 
acquiring other enterprises or merging, being acquired, restructuring of management or of basic 
staff working conditions (contracts, working time, flexibility).43 

•  Decrease of trade union influence or worker participation regarding labour relations.  
•  Liberalisation  of  labour  legislation,  creation  of  ‘new  forms  of  work’  and  new  contract  types, 

beyond the permanent full-time employment.44 

•  New forms of management, application of management concepts like just-in-time production or 
lean  management,  higher  flexibility  of  production  and  higher  customer  orientation, 45 

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segmentation  of  enterprises 
externalisation/subcontracting of service areas like cleaning, canteen, security and so on. 
Increased  communication  and  interdependency,  time  coordination  and  synchronisation 
requirements between units, enterprises and in supply chains.  

into  profit  centres,  quality  management  obligations, 

• 

•  Less direct supervision and more objective and results-based management. 
•  Last but not least the massive introduction of ICT and other work-intensifying technologies. 

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The main reasons for stagnation after 2005 might be that many of the above-mentioned concepts or 
policies were developed or had their peak during the 1980s, 1990s or the first decade of the 21st century. 
Some of them lost their dynamic (e.g. privatisation), or have become a kind of standard (management 
by objectives), or were widely implemented in the first decade of the 21st century (ICT facilities at most 
workplaces); also, some negative impacts on working time were mitigated by state interventions (i.e. the 
EU Working time directive46) or labour agreements.47 

Of  particular  interest  for  OSH  probably  is  that  the  changes  in  labour  legislation,  the  production  in 
international supply chains and technological improvements were sufficiently developed to shift quite a 
relevant  part  of  work  to  other  types  of  contracts,  that  is,  to  subcontractors,  self-employed  or 
temporary agent workers and other forms of non-standard work contracts. Reasons were economic 
savings but also better management of intense work periods, peak times and risky work.  

These developments are probably the main reason that work intensity stayed at a similar level for the 
employed  workers  with  a  standard  contract  while  the  working  conditions  of  other  types  of  work 
degraded.  EU-OSHA  has  taken  this  conclusion  already  in  2002  in  its  report 48 on  ‘New  Forms  of 
Contractual Relationships and the Implications for Occupational Safety and Health’:  

‘1.  the  transfer  of  risks  in  the  (practical)  conditions  of  work  to  non-permanent  employees  and  to 
subcontractors;  
2. segmentation in the workforce based on differences in contractual conditions of employment (working 
hours, job insecurity, and qualifications).  
In the first scenario, risks directly related to working conditions (bad ambient and ergonomic conditions) 

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are  shifted  towards  non-permanent  workers  and  subcontractors,  who  have  less  protection  and/or 
knowledge to cope with these risks. This scenario is not easy to verify in quantitative data, although it is 
frequently stated in case study research.’  

Also, Eurofound draws such conclusions on the impact of subcontracting on working conditions:  
‘First, employees in subcontracting perceive higher health and safety risks, notably through more work-
related accidents and increased time pressure. Second, there are a number of psychological risk factors, 
such as perceived economic insecurity and worries about losing one’s job, that are more likely among 
subcontracting workers.’49 

There is even an evident relation between such forms of employment and higher rates of work 
accidents. In a first systematic review the authors conclude: 50 
‘This review supports an association between some of the dimensions of precarious employment and 
occupational  injuries;  most  notably  for  multiple  jobholders  and  employees  of  temp  agencies  or 
subcontractors at the same worksite. However, results for temporary employment are inconclusive.’ 

OSH Barometer – Mental risks: 

https://visualisation.osha.europa.eu/osh-barometer/working-conditions-preventions/working-
conditions 

ESENER – Data visualisation: 

https://visualisation.osha.europa.eu/esener/en/survey/datavisualisation/2019 

3.2  Physical health risks at work  
Risks at work that can result in physical harm can be divided into safety and health risks. 

The  main  result  of  insufficient  safety  is  a  work  accident.  A  work  accident  has  as  immediate 
consequences  either  a  personal  injury,  a  disease,  or  death  of  one  or  more  workers.  Eurostat 
distinguishes between non-fatal and fatal work accidents, and for the majority of sectors it provides also 
the duration of the absence due to the accident — an indicator for the severity of the injury. Non-fatal 
accidents  at  work  can  cause  medium-  or  long-term  health  consequences,  and  in  the  worst  case  a 
permanent disability. 

ILO  Definition  of  accident:  ‘An  occupational  accident  is  an  unexpected  and  unplanned  occurrence, 
including acts of violence, arising out of or in connection with work, which results in one or more workers 
incurring a personal injury, disease or death.’51 

Physical health risks can be caused by a variety of circumstances and exposures or by inadequate 
ergonomics. Natural circumstances at work can pose such health risks, that is, temperature, storms 
and floods, unsafe terrain, biological agents and so on; or the risks are due to manmade circumstances, 
that is, work in buildings, on roofs and towers, on traffic routes, under artificial ventilation. Exposure is 
a  general  term  to  describe  the  interaction  between  environment  /  emissions  /  contaminants  and  the 
human organism. In a workplace context, ‘exposure’ mainly covers emissions from machinery or from 
tools and materials, for example, noise, vibration, dust, electromagnetic fields and chemical substances. 

Risks from inadequate ergonomics harm in particular the musculoskeletal system. Ergonomic risks of 
manual work are typically caused by repetitive hand and arm movements, tiring positions, for example, 
permanent kneeling or overhead work, lifting and moving of heavy loads, or of patients and so on. A 
certain  ergonomic  risk  is  physical  inactivity,  in  practice  sitting  most  of  the  working  time.  Not  only 
administrative  tasks  but  also  many  occupations  in  service  or  industry  require  permanent  sitting,  for 
example, drivers, cashiers, part assembly operators and so on (often called ‘sedentary occupations’). 

In  general,  the  EU-wide  surveys  (self-reported  working  conditions  or  health  problems)  show  a  high 
prevalence of ergonomic risks. Between 40% and 65% of the respondents in ESENER and the EWCS 
report classical ergonomic risks. A quite constant share of workers reports physical exposures like 
noise, vibrations, high or low temperatures and exposure to chemical and biological agents; depending 

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on  occupation  and  sector,  between  15%  and  30%  of  workers  are  exposed  to  such  risks. No  or  very 
minor decreases of these risks could be seen during the past 15 years. 

In both the ESENER and the EWCS surveys52 there is a similar share of ‘Yes responses’ when asked 
for the  presence of such risks.53 In ESENER a set of questions  is related to  the risks present  in the 
enterprise. The figure below shows the responses from ESENER 2014 and ESENER 2019 regarding 
physical health risks.54  

Figure 16: Exposure to physical risks – ESENER, EWCS and LFS 

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Table 2: Physical risks present in enterprises EU27 (in %) – ESENER 2014 and 2019  

In the short period of five years from 2014 to 2019, some significant changes of ergonomic risks 
could be observed. ESENER reports that more enterprises have to deal with lifting or moving people or 
heavy loads (increase from 47.4% to 51.7%) and repetitive hand or arm movements (up from 52% to 
65%). Physical risk and safety risks stagnate.  

The EWCS data also show in most areas only a minor increase or decrease of physical health risks 
(between 2005, 2010 and 2015). Overall, the data are quite similar to the findings of ESENER.  

European Agency for Safety and Health at Work – EU-OSHA 

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In some cases, the differences between the survey questions led to different results, for example, in 
ESENER 2019 52% respond ‘Yes’ to the question ‘Lifting or moving people or heavy loads’; in the EWCS 
32%  respond  ‘Yes’  to  the  question  ‘Carrying  or  moving  heavy  loads’  and  10%  respond  ‘Yes’  to  the 
question ‘Lifting or moving people’, which makes in total 41%.55  

Table 3: Physical risks (in %) – EWCS 2005, 2010 and 2015  

The  2015  data  are  the  sum  of  responses:  ‘Almost  always’  and  ‘Between  ¼  and  ¾  of  the  working  time’,  or  the 
response ‘At least ¼ of the working time’.  

The  LFS  Ad  hoc  modules56 show  much  lower  values  —  between  3%  and  10%  —  due  to  a  different 
methodological approach, that is, the interviewees had to determine one risk factor that they regarded 
as the most important of 11 risk factors.57 

Table 4: Physical risks (in %) – LFS Ad hoc Survey  

A main factor for comparatively higher physical health risks in a country is the different share of 
sectors in the economy. However, there is only a statistically significant correlation but not always an 
unambiguous relation between sectors and physical health risks.  

Countries with a high share of the sectors industry, agriculture and construction show in general 
higher  values  regarding  physical  health  risks  from  exposure  to  vibrations,  noise  and  dangerous 
substances, for example, Romania (highest share of these three sectors), Poland (second highest share) 
and Hungary (seventh highest share). Still, two countries with a high share of employed persons in these 
sectors like Bulgaria  and Czechia cannot be found  in  the list of the seven countries with the highest 
share  of  employees  exposed  to  these  physical  health  risks;  Slovakia  and  Slovenia  are  only  found 
regarding the exposure to loud noise. These data give an indication of the sectoral spread of physical 
health risk but cannot explain every country situation in detail. 

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Table 5: Physical health risks, Sectors and exposures – EWCS 2015  

Country colours: Romania aquamarine, Poland orange, Hungary blue. 

The  figure  below  illustrates  country  differences,  based  on  data  from  the  EWCS  2015:  the  values  of 
Ireland (green), the EU28 level (blue) with numbers, and the values of Poland (orange). Poland had a 
relatively high share of employment in industry of 24%, for which Ireland has a share of 12%. The impact 
on working conditions can be seen in the share of workers reporting exposures to vibrations (Poland 
27%, Ireland 16%) and loud noise (Poland 35%, Ireland 25%). 

Figure 17: Physical health risks compared (%) – EWCS 2015  

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In a similar way, the levels of ergonomic  risks are  related with the sectoral structure of a country, 
determining  the  type  of  occupations  and  work  tasks.  EU-OSHA  provided  a  detailed  analysis  of  the 
prevalence  of  musculoskeletal  disorders  (MSDs)  and  the  related  risk  factors  in  several  studies  on 
musculoskeletal diseases, for example, ‘Work-related musculoskeletal disorders: why are they still so 
prevalent?’58 

An example of the interrelation between sectors and risks is the connection between the sector 
aggregate ‘Trade, transport, food/accommodation and recreation activities’ and three major indicators 
of  ergonomic  burden,  that  is,  ‘Painful,  tiring  positions’,  ‘Repetitive  hand  or  arm  movements’,  and 
‘Carrying or moving heavy loads’.  

Seven countries have a share of employees in this sector of more than 30% (Cyprus, Greece, Spain, 
Malta, Bulgaria, Croatia and Latvia), and many of them are present in two or three lists of countries with 
the highest number of responses regarding the indicators.  

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Table 6: Physical health risks, Ergonomics – EWCS 2015  

Country colours: Cyprus aquamarine, Greece orange, Spain blue. 

The exposure to painful and tiring positions and hand/arm movements are highest in southern and 
eastern EU Member States. They also seem to be closely correlated to the sector aggregate ‘Trade, 
transport, food/accommodation and recreation activities’. Moving and carrying  heavy loads  is also 
connected to the sectors agriculture, manufacturing and construction — Romania, Latvia, Slovakia and 
Spain  are  part  of  the  top  seven.  Looking  at  the  countries  for  the  share  of  workers  who  are  lifting  or 
moving people, Romania, Sweden and Ireland are the countries with the highest shares (15%, 14% and 
13%).  

Regarding  occupations,  manual  workers  —  craft  workers,  plant  and  machine  operators,  and 
agricultural workers — have the highest score of posture-related risks and ambient ergonomic risks. 

Table 7: Physical health risks, Ergonomics – EWCS 201559 

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Looking  at  the  data,  it  is  quite  obvious  that  the  northern  and  the  central  European  countries  are 
underrepresented in the group of countries with the highest share of physical and ergonomic risks. The 
central European countries (Austria, Germany, the Netherlands, Belgium, Luxembourg and France, and 
the two northern European countries Denmark and Sweden) are practically not present in these lists. 
The  picture  changes  if  it  is  about  lifting  or  moving  of  people,  a  consequence  of  the  relatively  larger 
relevance of care work in these countries.  

Physical inactivity and permanent or prolonged sitting or standing is a specific ergonomic risk with 
health  impacts  for  the  musculoskeletal  system  but  also  contributing  to  other  health  impacts  like 
cardiovascular diseases, tendency to overweight and so on.60 According to ESENER 2019, the second 
most frequently reported risk factor in the EU27 was prolonged sitting. By sector, it was most frequently 
reported by enterprises in financial and insurance activities (92% of establishments in the sector in the 
EU28), information and communication (92%), and public administration (89%). On average, three to 
four hours of this sedentary behaviour occurs at work. In the EU, 28% of workers report that their work 
involves sitting almost all the time and a further 30% report sitting a quarter to three quarters of the time, 
and throughout Europe 18% of the workers sit more than 7.5 hours a day. 

As mentioned in previous chapters, there exists a share of workers exposed to physical risks that is 
prevalent in spite of all structural and sectoral changes. Some of the structural changes of the economy, 
for example, from industrial production to maintenance and repair, 61 might even cause higher ergonomic 
risks; in general it will be more difficult to use technical help tools in varying maintenance and repair 
situations, compared to more homogenous tasks in industry. Growing sectors, for example, home care 
of  ill  or  elderly  people,  involve  ergonomic  risks  due  to  transport  and  moving  of  patients  and/or  tiring 
positions. 

OSH Barometer – Physical risks: 

https://visualisation.osha.europa.eu/osh-barometer/working-conditions-preventions/physical-
risk/vibrations-loud-noise-and-temperature 

ESENER – Data visualisation:  

https://visualisation.osha.europa.eu/esener/en/survey/datavisualisation/2019 

EU-OSHA Themes – Musculoskeletal disorders: 

https://osha.europa.eu/en/themes/musculoskeletal-disorders 

3.3  Contract types and work locations  
The chapter deals with the impact of non-standard types of work on working conditions in comparison 
to standard work, focusing on the impact of the ‘Conditions of employment’ on OSH.  

Most studies that dealt with the connection between the employment forms and health outcomes 
and in particular safety and health aspects found significant correlations. 62 A census-based study from 
Belgium on non-standard forms of work and mortality from Belgium concluded (2021):  

‘Our  study,  which  to  our  knowledge  is  the  first  one  to  assess  associations  between  forms  of  non-
standard  employment  and  mortality  using  population-wide  data,  revealed  considerable  mortality 
inequalities within the salaried employee population in Belgium. Over the subsequent 13 years and three 
months  of  follow-up,  certain  non-standard  workers  were  at  increased  risk  of  death  compared  to 
permanently employed workers.’63 

The conventional non-standard types of work start with widespread temporary (or fixed-term) work, 
seasonal work, casual work, remote work in different forms (at home or other places), self-employed 
work, family work, mobile work in transport and often in construction, domestic work, care and craft work 
at the places of clients, plus several types of less regular and undeclared work.  

High public awareness is directed to those types of non-standard work that are connected either to new 
forms of contracts (voucher, platform, zero-hours, etc.) or new types of work made possible by the 

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use of modern and powerful ICT technologies, or a combination of those two forms. Depending on the 
work tasks, ICT infrastructures enable complete independence and separation from the premises of the 
employer. In addition, they open opportunities for new forms of contracts and can go along with blurred 
OSH responsibilities.  

These forms of work often have as a major quality (feature) a less clear employer–employee relation. 
The main structural element of the EU OSH legislation is the dual role of employers and employees in 
OSH. The employer has the overall responsibility for OSH (Framework Directive Article 5: ‘… duty 
to ensure the safety and health of workers in every aspect related to the work …’), and the worker the 
obligation to contribute (Framework Directive Article 13 … ‘to take care as far as possible of his own 
safety and health and that of other persons affected by his acts or omissions …’). Where OSH legislation 
has to be applied in less clear employer–employee relations, for example, in the case of self-employed, 
the relevance and impact of ‘dyadic’ OSH regulations seem to fade.  

Not only the EU is struggling with this development, but Australia also introduced the legal identity of a 
PCBU:  ‘Significantly,  the  primary  duty  of  care  will  shift  from  the  “employer”  to  the  broader  “person 
conducting a business or undertaking” (PCBU) and duties previously owed to “employees” will now 
apply to all workers.’64 

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During  the  past  decades,  and  especially  after  1990,  a  much  greater  variety  of  such  contractual 
relations has emerged. However, in 2019 the conventional employment contract (part- or full-time) still 
accounts for around 86% of the workforce (EU27), they are employees. Seventeen per cent of these 
employed persons have a part-time contract, 13% of the employees have a temporary contract, or both 
combined. Nine per cent are self-employed without employees. The remaining 4% are self-employed 
with employees (employers) and 1% are contributing family workers. The number of self-employed in 
agriculture halved between 2005 and 2019, which is the biggest factor in the reduction of contributing 
family workers and the stagnation of the number of self-employed. 

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Figure 18: Employment types in EU27, development 2005 to 202265  – Eurostat 

The minor deviation of the sum of the different types of employment to the 100% ‘Employed persons’ is due to ‘No 
response’ answers. The data of part-time employees and of employees with a temporary contract are for the full 
year 2019, not for Q4. 

The group ‘employees’ is characterised by two major contractual distinctions that are important for 
OSH:  1)  full-  or  part-time  work,  and  2)  the  time  limit  of  the  contract  (indefinite  or  temporary). 
Moreover, in many Member States there are major differences between employment contracts of private 
employers in comparison to public employers.  

Definitions Eurostat 66 

Employers = self-employed with employee: employing one or more employees: persons who work 
in their own business, professional practice or farm for the purpose of earning a profit and who employ 
at least one other person.  

Self-employed: not employing any employees (self-employed without employees): persons who work 
in their business, professional practices or farm for the purpose of earning a profit and who employ no 
other persons.  

Employees: persons who work for a public or private employer and who receive compensation in the 
form of wages, salaries, fees, gratuities, payment by result or in kind. 
Contributing family workers: persons who help another member of the family to run a farm or 
business, provided they are not classed as employees.  

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The quantitative amount of other non-standard types of work often is not well statistically monitored 
but based on estimates. There are several difficulties to generate reliable statistical data: many of these 
types of work are less regular, they can be below the level of notification obligations or fully undeclared, 
obligations for statistical notification are not issued or not followed, and/or these types of work are done 
in parallel together with other forms of work or income. The OECD estimates that the group with the 
highest share of these types of work are pensioners who perform such work as a second job. 67  

A special case of contract types are posted and seasonal workers68 in the EU. Their numbers have 
been estimated, for example, in annual reports on ‘Labour mobility’.69  

Table 8: Posted and seasonal workers – Eurostat  

Regarding posted workers a recently published report shows the diversity of working conditions, a low 
availably of data and the high risk of infringements.70  

Concerning seasonal workers several deficits of OSH were made public, particularly during the COVID-
19 pandemic. The European Commission guidance on ‘Seasonal workers’ states: 71  
‘… due to the nature of their work, seasonal workers are often more vulnerable than other workers to 
situations such as precarious working and living conditions, infringement of labour law, inadequate social 
security coverage, as well as undeclared work. Practices that ensure that employers and workers are 
provided with correct information and assistance can prevent or address these issues.’ 

Overall, the OECD estimates that the quantitative amount of all types of non-standard work is more 
than  30%  of  employment:  ‘All  types  of  non-standard  work  combined,  non-standard  employment 
accounts for more than one-third of employment in OECD countries.’ 72  

The OECD also estimates that in 2019 the new forms of non-standard work account for 0.5% to 3% 
of  total  employment.73 They  highlight  the  change  from  traditional  non-standard  work  to  new  forms: 
‘Non-standard work is undergoing substantive transformation. In recent years, the decline of some types 
of self-employment including in agriculture has been partly offset by the emergence and expansion of 
new forms of non-standard work, in particular jobs relying on new technologies, such as platform-based 
taxi-like drivers. While today this type of work accounts for only 0.5-3% of total employment in developed 
countries,  it  is  of  considerable  importance  for  young  people  who  rely  on  new  forms  of  work  more 
frequently than older generations and some of whom seem to set a higher value on work autonomy.’ 74 

The extrapolation of these OECD estimates to the EU27 indicates that the amount of new forms of 
non-standard work (i.e. beyond temporary contract or part-time) would be in a range between 1 million 
and 6 million persons in the EU27. 

Eurofound distinguishes in its 2020 report on ‘New forms of employment’75 between nine different types: 
ICT-based Mobile work, Platform work, Casual work, Employee sharing, Job sharing, Voucher-based 
work, Collaborative employment, Interim management and Portfolio work. They report several estimates 
about  the  scale  of  these  types  of  work  per  Member  State  but  they  do  not  present  final  quantitative 
estimates for the EU level.  

Obviously, as the term ‘non-standard’ already indicates, these types of work and their consequences 
are  much  less  documented  and  less  visible  than  regular  forms  of  employment.  To  gain  a  better 
quantitative picture of the safety and health situation under such working conditions based on 
administrative data, advanced administrative and research efforts would be necessary,76 for example, 
a strong collaboration between labour inspections (and other OSH authorities) and those authorities that 
are  supervising,  enforcing  and  policing  labour  law  and  obligatory  social  security  regulations,  from 
employment services to police forces. 

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3.4  Mobile work, home as workplace and domestic work  
The place of work — premises of the employer or any other place — is another major characteristic of 
working conditions, which significantly influences the risks and the preventive measures. This chapter 
takes a closer look at three types of work, that is, mobile work, private homes as workplace and domestic 
work, All pose — in a broad sense — similar challenges for OSH.77 

For OSH, the major question for all mobile and non-stationery work is: to what degree does the 
OSH level at these workplaces’ deviate from the OSH level at stationary workplaces? Current OSH 
legislation illustrates these difficulties: The Workplace Directive78 excludes several types of mobile work, 
and the Display screen equipment directive 79 was issued in 1990 and does not reflect the variety and 
specific OSH issues of digital equipment development of the past 30 years. Both directives are currently 
under revision.  

Mobile work is a standard characteristic of work in the construction and transport sector, extreme 
for workers in the maritime and other long-distance and international transport sectors, often in tourism 
and also for certain categories of sales personnel, and often standard for qualified craft workers during 
service or construction of plants and installations and during maintenance. 80 

Triggered  by  developments  in  digital  and  communication  technologies,  several  new  types  of  mobile 
work  have  developed.  In  principle,  the  place  of  work  can  be  anywhere,  in  a  car,  train,  hotel,  at  the 
premises of other employers, at remote office-like locations, or at the client’s workplace or at private 
homes of clients; it is not ‘place-bound’. Most of this mobile work still takes place in the contractual form 
of regular employment, but mobile work is also a major field for many new forms of new work contracts, 
triggered by the technological possibilities.  

Traditional home-based work consists of the production of small goods that — from a technical point 
of view — can be produced in private homes (clothes, artisan work and very repetitive work like sorting). 
This work is performed for an enterprise or a person contracted by the enterprise for the organisation of 
home-based work and is located at the homes of the workers. It might require extra technical equipment, 
but sometimes usual private equipment is sufficient. The traditional home-based work very probably has 
decreased to a low level, the quantity of this type of home-based work is not monitored at EU level.81 
Regulation of OSH for such home-based work has a long tradition in OSH legislation, mostly aimed at 
achieving working conditions as similar as possible to the other employees in an enterprise, regarding 
wages, social protection, and safety and health.  

Work  at,  from  and  in  homes.  We  can  distinguish  major  types:  work  at  (own)  home,  either  as 
independent work (self-employed) or classical home-based work; work from private home embedded 
in daily routine work processes in an enterprise or institution; and work in homes of others. Long-term 
care work, domestic work and teaching are large categories of work in homes; the work is performed in 
the  private  homes of clients. Regarding work that is  done at  home, from home and in homes, the 
application of some basic OSH standards has to take into account the dominantly private character of a 
home.  This  triggers  the  question  of  responsibility  and  supervision:  Who  is  responsible  for  risk 
assessment and prevention measures? Is a supervision of compliance by state  authorities in  private 
homes legally possible?  

The craft workers who are doing technical services in homes of clients are statistically not counted as 
home workers but as workers at the premises of clients (Eurostat). In some important OSH aspects, it 
is similar to the work of the other professions; these service workers fulfil their work tasks in a private 
environment where the employer can hardly perform a risk assessment, for example, of the electrical 
appliances or safety of floors, handrails or roofs. The risk assessment is done by the worker on the spot, 
based on experience. This is similar to short-term care work.  

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Table 9: Types of work: in, at and from home 

Eurostat estimates the numbers of workers in three categories of non-stationery workplaces: 

•  employed persons who work from home (covering mostly the three groups ‘Traditional work at 

home - production’, ‘Traditional work at home - services’, and ‘Teleworking’);  

•  at the place of clients, for example, in domestic services and craft; 82 and  
•  at non-fixed or other places. 

The estimate for work from home before 2020 was at around 5.7 million or 2.9%. 83 Work at the ‘client’s 
place’ is common for more than 9% or 18.5 million employed persons. More than 16 million workers 
work at ‘Non-fixed or other places’ that refers to a large proportion of workers in transport, tourism, 
construction and craft. 

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Figure 19: Employed persons by main place of work – Eurostat 

The discrepancy to the total number of employed persons and work at home in Eurostat statistics is due to the 
different approach in the LFS Ad hoc survey 2019 compared to the regular LFS survey. Note that depending on the 
type and point of time of Eurostat surveys, the data can be different. 

Eurostat reports additional figures for work from home, based on the regular LFS survey for the EU27:  

‘The percentage of  employed persons aged  15 to  64  in the European Union (EU) who usually  work 
from  home  stood  at  5.0%  in  2017.  This  figure  was  highest  in  the  Netherlands  (13.7%),  followed  by 
Luxembourg (12.7%) and Finland (12.3%), and lowest in Bulgaria (0.3%) and Romania (0.4%).’  84 

The numbers looked quite different in 2020 and in 2021; in 2021 ca. 13.4% of the employed persons 
worked usually from home, that is, more than 25 million. This figure will probably even out to a more 
stable level in 2023/2024 after new post-pandemic teleworking arrangements come into force.85 

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Figure 20: Employees working mostly from home (in % of employed persons) – Eurostat86 

Note: No data for Sweden for 2020 

Some examples — domestic work, care work and ICT mobile work — might illustrate specific situations.  

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Domestic work  is work performed within  households to provide services mainly for consumption  by 
household  members.  Domestic  workers  perform  household  and  personal  services  in  one  or  more 
different homes.87 Approximately 9.5 million people work as domestic workers, 6.3 million declared 
and  approximately  3.5  million  undeclared.88 In  general  these  workers  suffer  from  precarious  working 
and  employment  conditions.  EU-OSHA  described  —  based  on  the  opinion  of  sector  experts  —  the 
biggest deficits regarding technical support for better working conditions as follows:  

• 

‘PPE (Personal Protective Equipment) : that covers a large number of conditions encountered 
by  PHS  (Personal  and  Household  Services)  workers  and  intended  to  prevent  possible 
occupational accidents in the sector; 

•  Equipment: that meets ergonomic requirements and increases work efficiency; 
•  Products:  taking  into  account  medical  health  (skin  disorders,  lung  problems,  etc.),  the 

environment and the effectiveness of products’. 89 

Care work in private homes can be a mixture of short-term and repeated mobile work at the home of 
clients but also fully residential at the home of the care receiver. Of all care workers, 71% worked in 
residential care and 29% worked in non
residential care, that is, they worked at the homes of the care 
receiver; 81% of all care workers are female. The number of care workers grew from 4.7 million in 2009 
to  6.3  million  in  2019  and  made  up  3.2%  of  the  entire  EU  workforce  in  2019,  ranging  from  0.3%  in 
Greece to 7.1% in Sweden.90 Twenty-nine per cent of these 6.3 million care workers do their work at 
the clients’ places, this makes roughly 1.8 million workers.  

‐

Eurofound has analysed the working conditions in long-term care (or LTC), that is, the support and 
care for a long-term or permanent care receiver, not only for some days or weeks to overcome a specific 
short-term emergency.91 They summarise: 

•  LTC workers often report that they do not believe they will be able to keep working until the age 

of 60.  

•  LTC workers often do shift work, in particular rotating shifts, and feel that they have no say in 
their working arrangements; they are often requested to come to work at short notice. Evening, 
night and weekend work is particularly frequent in residential LTC.  

•  Two

fifths (40%) of LTC workers report lifting or moving people more than three

quarters of the 

time (compared with 5% of all workers and 23% in healthcare). 

‐

‐

Live-in care is a special form where the carer lives permanently in the house or flat of the care receiver. 
Eurostat data are not available but national estimates are available for some countries; the estimate for 
Italy is 160,000 and for Germany 300,000. 92  

Overviews of the quantity of ICT-based mobile work93 demonstrate that such schemes exist in many 
enterprises  and  workplaces,  particularly  for  clerical,  managerial  and  professional  tasks.  For  a  large 
share of clerical workers, it has become — latest with the push of the 2020/2021 pandemic — a usual 
way of working. The highest proportions of workers with arrangements for ICT mobile work are found 
int  the following sectors: information and communication (57% of workers  in  the  sector), followed  by 
professional  and  scientific  activities  (53%),  financial  services  (43%),  real  estate  (43%)  and  public 
administration (30%).  

Which working conditions characterise these groups of home workers and mobile workers and different 
types of work from, at and in homes?  

As mentioned before, the principal question for all these types of non-stationary work is: to which 
degree  does  the  OSH  level  at  these  workplaces  at  home  or  mobile  deviate  from  the  OSH  level  at 
stationary  workplaces?  And  which  of  these  deviations  are  unavoidable,  and  where  are  better 
OSH solutions possible?  

Main issues are:  

• 
• 

space (in cars, trains, hotels, private flats, etc.);  
less well-adapted work equipment, for example, possibilities for ergonomic equipment at 
mobile workplaces;  

•  availability of tools, that is, for example, lifting equipment in home care; 
• 
•  emergency facilities, for example, fire extinguisher;  

certain facilities like toilets, for example, at construction sites, for bus drivers; 

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•  often less secure electrical systems and inadequate light levels; 
•  unsafe equipment in households like private ladders, unknown chemical products to be used 

by domestic and care workers; 
•  unsafe stairs, handrails and so on; 
• 
temperature and ventilation; 
•  noise. 

It  is  evident  that  often  it  is  not  possible  or  very  difficult  to  realise  at  every  mobile  workplace  a 
standard  close  to  that  of  a  stationary  workplace.  It  is  a  permanent  challenge  for  legislators  and 
supervisors, which minimum limits have to be fulfilled, and at what point these working conditions pose 
a significant health risk where regulation of minimum standards is needed.  

A  major  issue  during  the  pandemic  of  2020/2021  was  the  drastically  increased  number  of  office 
workers doing remote or telework who used without much preparation time mobile digital equipment 
in an often not well-adapted private home. The EU legislation closest to the OSH aspects of ICT work 
and mobile ICT work are Directive 89/654/EEC (Workplace Directive) and Directive 90/270/EEC 
(Display screen equipment DSE Directive) that set standards for stationary workplaces. However, the 
Workplace Directive excludes mobile workplaces, and the Display screen equipment directive refers to 
the technological situation of the nineties, that is, large monitors and desktop computers. As determined 
in the EU Strategic Framework 2021 to 2027 both directives will be revised in the next year; this revision 
might  extend  the  scope  to  mobile  workplaces  that  are  until  now  excluded  and  refer  to  the  current 
technological status of IT devices.  

Beside these, there are uncertainties in the application of OSH regulations for mobile workplaces 
or in private environments: unclear responsibility and lack of risk assessment in mobile work and work 
at, in and from homes, pose an additional risk in OSH. Methods of risk assessment — if performed at 
all — differ substantially from risk assessment methods at premises, where employers, professionals 
and state supervisors have direct access to the workplace and control over most of the technical and 
organisational conditions. 

In response to this increase in non-standard work, governmental institutions, business federations and 
unions developed new formats of information that take into account a higher degree of individual 
responsibility and a decrease in employer oversight and responsibility. OSH institutions promote 
and amplify good examples that already exist. Information via ICT devices has become a popular way 
of communication. Examples are interactive response tools that tailor the response to the needs of 
the  users  including  employers,  workers  and  OSH  practitioners  (e.g.  EU-OSHA's  OIRA),  and  visual 
resources (NAPO videos, EU-OSHA). Some Member States have introduced OSH-specific helpdesks, 
for example, KOMNET. 94 

3.5  Worker groups with specific risks and needs  
Already in 1996 the European Commission identified in its ‘Guidance on Risk Assessment at Work’95 
‘sensitive  risk  groups’  as  workers  with  disabilities,  young  and  old  workers,  pregnant  and  nursing 
mothers, and untrained or inexperienced workers including temporary or migrant workers. Often these 
groups  are  addressed  as  ‘Vulnerable  groups’ 96 or  ‘Groups  at  risk’. 97 Other  institutions  and  authors 
include  older  workers,  women,  self-employed  or  low-qualified  workers,  and  the  ILO  includes  also 
workers  in  the  informal  economy.  All  these  ‘assignments’  refer  either  to  individual  (endogenous) 
characteristics or to the position on the labour market.  

The scientific literature on the group-related particular risks for health and safety at work is very broad. 
EU-OSHA and practically all national and international OSH organisations have published studies and 
provided fact sheets and guidance documents. An overview on such publications shows that awareness, 
knowledge  and  policies  in  and  outside  enterprises  have  substantially  developed  and  increased,  but 
there is less evidence about progress in practice. 

The textbox below shows some of these specific characteristics for five groups: women, migrants, low-
qualified workers, ageing workers and young workers. The Directorate-General for Internal Policies of 
the Union compiled this in 2010, based on several EU and OECD background documents.98 

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Women 

· Most women in the EU bear the main responsibility of household work and childcare. The health 
risks from this non-paid work add up to the risks from their paid work; this double burden in general is 
not, however, considered when addressing occupational health problems faced by women.  
· In surveys, about 6% of women under 30 in the EU have reported sexual harassment at work 
(though this may be an under-estimate).  
· Overall, women report fewer work-related accidents than men, but higher levels of work-related 
health problems, including MSDs and stress (see also the overview in the EIGE ‘Gender statistics 
database’, section: Working conditions).99,100 

Migrants 

While a minority of migrant workers hold high-skilled jobs, many have jobs that are “dirty, dangerous 
and demanding” and consequently face high risks of work-related accidents and disease.  
· Language and cultural barriers also contribute to higher risks for migrant workers.  
· While EU-wide statistics are not available, country studies confirm that migrant workers suffer higher 
levels of work-related accidents and disease. Health and safety risks are believed to be higher for 
undocumented migrant workers although, because of their situation, there is a lack of data on their 
conditions. 

Low-qualified workers 

· Low-qualified workers are found mainly in traditional sectors, including manufacturing, agriculture, 
construction, wholesale and retail trades.  
· Very often these workers have high-risk or elementary occupations that expose them to a higher rate 
of injuries and health-related problems.  
· Low-qualified workers have less autonomy, less responsibility and overall experience less job 
satisfaction than workers with higher qualifications. Most low-qualified workers have low-paid jobs and 
many have temporary contracts.  

Ageing workers  

· Ageing workers are more at risk of occupational health problems than younger workers because they 
have been exposed longer to certain hazards. Older workers report more work-related health 
problems than younger workers, with backache and muscular pain for more than 70% of workers aged 
55 and more. 
· Older workers are at lesser risk of non-fatal accidents because they have greater experience; 
however fatal accidents are more frequent than for younger workers. 
· Recovery time and return to work after illness are key issues to address when aiming to increase the 
employment rate of ageing workers. 

Young workers101 

· Overall, young workers have a higher rate of non-fatal injuries than older workers.  
· Young workers are more likely to be employed under non-standard forms of contractual 
arrangements such as part-time or temporary contracts. 
· Younger workers have less training, experience and maturity in their job, which puts them at risk of 
overestimating their physical capacities or underestimating the safety and health risks associated with 
their tasks. 
· A further concern is that exposure to workplace risks when young can contribute to later disease – 
this factor is not, however, addressed by worker health and safety surveillance. 

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EU-OSHA specifies the particular disadvantages and health and safety risks of women at work on 
its thematic website on women and health at work,102 and in several OSHWiki articles.103 

•  Work in specific sectors and specific types of work 
•  Balance dual responsibilities at work and home 
•  Are underrepresented at supervisor and management level 
•  Are physically different to men, although there is often more variation between women than 

between men and women, for example, in physical strength 
•  Do jobs that are often wrongly assumed to be safe and easy 

As mentioned, women have a lower accident rate but report higher levels of work-related health issues.  

Table 10: Accidents at work and health-related work problems, women and men – Eurostat104 

Also,  the  burden  of  household  work  is  still  higher  for  women.  Regarding  ‘Food  management  and 
cleaning’,  Eurostat  reports  a  much  higher  percentage  of  women  doing  these  household  tasks.  The 
participation rate of women is on average double that for men regarding food management and two to 
five times higher regarding cleaning.  

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Table 11: Time spent for household and family care, men/women –  Eurostat105 

Ageing  can  have  positive  consequences  on  safety  and  health.106 Depending  on  the  job  profile,  age 
might  be  an  advantage  if  work  experience  and  expertise  are  of  high  relevance. 107  The  biggest 
disadvantages are higher rates of physical functional limitations, possibly comorbidities and connected 
to  this  a  higher  rate  of  health-related  absences.  There  are  evident  differences  between  older  and 
younger aged workers regarding length of absences (not frequency) and disabilities, that is, not only 
recognised  serious  disabilities  but  also  minor  restrictions  can  be  sufficient  to  stop  a  physically 
demanding job.108 Manual workers of higher age run in competition with younger workers and mostly 
cannot  perform  physically  exhaustive  work  in  the  same  way  as  younger  workers.  From  a  preventive 
point of view, age-related limitations should as far as possible be mitigated by workplace adaptation and 
help tools.  

The higher accident rates of young workers are visible in the Eurostat ESAW statistics. In 2019, 
the standardised incident rate for non-fatal accidents of workers between 25 and 54 was at 2,469 for 
workers under 25, and at 1,667 for workers between 25 and 54 years, that is, ca. 48% higher.109  

Table 12: Non-fatal and fatal accidents at work – incidence rate by age – Eurostat110 

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The rate for fatal accidents was much lower for young workers; in 2019 it stood at 1.28 for workers under 
25, compared to 1.86 for workers between 25 and 54 years. 

The main reason for this difference is a high employment rate of young workers in sectors that are more 
prone to accidents than others, that is, wholesale and trade and hotels and restaurants. Moreover, they 
have a much higher rate of precarious types of employment, particularly temporary contracts, that is, 
they are often less trained and less experienced regarding risks at the workplace. 

Often one, two or more of these characterisations add to each other, that is, migrant, low-skilled and 
woman. The table below is one example of such ‘crossovers’. 

Table 13: Crossovers of health and safety risks among groups of workers (2010) – DG for Internal 
policies, policy department111 

In general, a weak position in the labour market  bears the risk of a low level of safety and health 
measures. Safety and health risks due to individual characteristics might also be underestimated if the 
mainstream of OSH measures is designed and implemented for the dominant group in an enterprise or 
sector. In many enterprises awareness and knowledge of OSH is focused on the core business while 
other  groups  are  regarded  as  auxiliary,  for  example,  cleaning,  canteen  and  drivers,  also  low-skilled 
clerical  workers  might  experience  a  missing  awareness  for  ‘minority  issues’  in  production-dominated 
enterprises. It can also be the other way around for manual workers who work in highly administratively 
dominated enterprises. 

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Some of these groups are directly addressed by European and national legislation, for example, 
workers with disabilities, young workers or pregnant women. For other groups of workers, for example, 
for women or  migrant  workers, the legislative protection  is formulated as  a general  ‘equal treatment’ 
prescription, like to provide preventive measures for all groups in an enterprise (Framework Directive, 
Article 15 ‘Risk groups’), or to provide solutions that fit to the individual (Framework Directive, Art. 6.2.d.). 
There are some prescriptions that refer to specific preventive activities, for example, to provide written 
instructions in different languages for safe work with chemicals. 

3.6  Conclusions  
The exposure to psychosocial risks is increasing, with mental health prevalence still emerging. Major 
work-related exposures have grown in the past 15 to 25 years that is, time pressure, difficult clients, 
longer working hours and poor communication. There is also some evidence that countries with over-
average  employment  in  sectors  like  health  and  care  or  other  human  and  client-oriented  services 
(education,  social  work,  tourism,  entertainment)  suffer  from  longer  working  hours  and  more  mental 
burden. The northern countries are at the top of the countries with highest mental burden. The southern 
countries have a high share of specific psychosocial risks related to work in tourism and entertainment, 
characterised by atypical working times and issues with difficult clients.  

EU-OSHA found in its ESENER 2014 data analysis: 112  
‘Concerning the sectors, national context appears to be related to differences in psychosocial risk 
management in all types of organisations, although in some sectors this relationship is weak. In the 
agriculture, forestry and fishing sector and the sectors of mining, construction, electricity, trade, 
transport, and accommodation and food, the low level of psychosocial risk management is observed 
also in a favourable national context. An explanation for this finding might relate to the large proportion 
of small organisations in these sectors, which, as concluded earlier, have poorer psychosocial risk 
management independently of the national context.’ 

There is a stable block of ‘conventional’ physical health risks — ergonomics and risk from the work 
environment — and ergonomic risks that did not significantly change since 1990. It varies between 15% 
for exposure to smoke, fumes and dusts to over 60% for repetitive hand/arm movements. Ergonomic 
risks develop  in two directions:  1) traditional risks stagnate in total, that is, lifting and moving heavy 
loads, painful or tiring positions, and shifts between sectors (from industry to transport, health and care); 
2)  risks  of  inactivity  and  highly  repetitive  hand/arm  movements  increase.  Beside  sectoral  and 
occupational  differences,  it  can  be  noted  that  in  general  higher  percentages  of  exposed  employed 
persons (workers and self-employed) are working in eastern and southern Member States. 

Since 2006 the average working time per week went down by 15 minutes for employees, and a slight 
reduction of most atypical — or unsocial — working times can be observed. Work intensification has 
emerged until 2005 but seems to stagnate since then. There are strong indications but no quantitative 
evidence on the extent to which working long hours, work at atypical times and probably also work with 
higher risks were transferred to workers in non-standard types of employment.  

Non-standard  forms  of  employment  are  —  according  to  EU-OSHA  —  characterised  by  a  non-
permanent employment contract and the work not being performed at the premises of the employer. 
Most studies that dealt with the connection between the employment forms and health outcomes 
and in particular safety and health aspects found significant correlations. New forms of employment 
have a wider spectrum of contract types — e.g. voucher, platform — and of places of work — for many 
types of work practically everywhere.  

Non-standard locations of work — mobile work, homes as workplaces, domestic and care work — 
have as common characteristics special conditions concerning implementation of OSH standards and 
legislation,  be  it  for  technical  or  legal  reasons.  Quantitative  evidence  on  working  conditions  in  these 
types of work is less available than for stationary workplaces; moreover, the OSH responsibility can be 
blurred.  Mobile  ICT  work  is  a  field  of  new  contractual  arrangements  that  besides  other  aspects  in 

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general reduce, limit or eliminate the employer’s duties — and in parallel also the workers’ obligations 
for occupational safety and health. These workers are often exposed to unhealthier working conditions 
and lower implementation of OSH standards and legislation. 113 

The legal obligation of an equal level of safety and health for all groups is difficult to convert into 
practice. Well-known but still very prevalent are the disadvantages of women, migrants, low-qualified 
workers, and ageing and young workers. The data show an unequal divide of specific risks, be it on 
purpose or due to missing awareness of the difference, or of lack of knowledge of the specific needs.  

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4  Trends in outcomes – safety, health and wellbeing  
Work accidents, work-related diseases and the level of work-related wellbeing114 are regarded as 
the three major health and safety outcomes of working conditions. They are used as lagging indicators 
(always  work  accidents  and  often  occupational  or  work-related  diseases,  sometimes  wellbeing) 
and  as  proof  of  evidence  in  political,  scientific  or  practical  discussions  about  the  quality  of  working 
conditions and the effectiveness and performance of the OSH system.  

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Work accidents are probably the most widely used indicator for assessment of the effectiveness of 
the OSH systems and the working conditions in general, also in a broader public; thus, this report will 
tackle  this  topic  more  extensively  than  other  topics.  Work  accidents  are  regarded  as  a  result  of 
insufficient safety prevention. Occupational and work-related diseases are regarded as short- or 
long-term  outcomes  of  all  disease-generating  circumstances  or  exposures  at  work,  caused  by  any 
type  of  material  or  substance,  by  unhealthy  physical  activity  or  unhealthy  inactivity,  or  by  disease-
causing aspects of human interaction at work. Occupational and work-related diseases are categorised 
and  assessed  by  experts,  particularly  by  medical  professions.  Wellbeing  is  the  newest  concept, 
covering the individual or group perception of the working conditions.  

The presence of risk factors and — if possible — the level of exposure makes up the largest block 
of datasets in the OSH Barometer that is used to assess working conditions. 

4.1  Trends in safety outcomes – work accidents 
The development of better safety standards, safety technologies and preventive organisational 
approaches  were  major  factors  to  achieve  a  steady  reduction  of  work  accidents  and  fatal  work 
accidents  during  the  last  30  years.  This  is  caused  by  crucial  improvements  in  safety  measures  and 
technologies, by practical implementation of these measures in enterprises, by scientific developments, 
and  crucially  supported  by  the  legal  obligation  to  apply  a  comprehensive,  proactive  and  preventive 
approach, as introduced in the EU Framework Directive.  

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The success of these efforts can be demonstrated by Eurostat’s work accident data. In 1998, Eurostat 
registered in its — just in 1994 introduced — ‘European statistics on accidents at work’ (ESAW) an 
incidence rate115 of non-fatal accidents of 4,089 (Sector A and D-K, NACE Rev. 1.1, EU-15).116 This 
incidence rate fell to 1,713 in 2019 (Sector A, C-N, NACE Rev. 2, EU27). 117 That is, between 1998 
and 2019 the incidence rate of non-fatal accidents in these sectors fell about 58%. According to 
ESAW, the total number of non-fatal accidents for all NACE classes in 2019 was 3,140,950. 118 

The incidence rate for fatal accidents dropped from 5.03 in 1998119 to 2.17 in 2019,120 that is, between 
1998  and  2019  the  incident  rate  of  fatal  accidents  decreased  by  57%.  The  total  number  of  fatal 
accidents in 2019 was 3,408.121 

The incidence rate of accidents for all NACE sectors is slightly lower. For non-fatal accidents, it stands 
at 1,603 (compared to 1,713 for Sector A, C-N, NACE Rev. 2, EU27)122; for fatal accidents the incidence 
rate is 1.74 (compared to 2.17 for Sector A, C-N, NACE Rev. 2, EU27); all data for 2019. 123 

1998 using NACE Rev. 1 Sector A, D-K: 
A Agriculture, hunting and forestry, D Manufacturing, E Electricity, gas and water supply, F Construction,  
G Wholesale and retail trade; repair of motor vehicles, motorcycles and personal and household goods,  
H Hotels and restaurants, I Transport, storage and communication, J Financial intermediation, K Real estate, 
renting and business activities.  
2019 using NACE Rev. 2 Sector A, C-N: 
A Agriculture, forestry and fishing, C Manufacturing, D Electricity, gas, steam and air conditioning supply, E Water 
supply; sewerage, waste management and remediation activities, F Construction,  
G Wholesale and retail trade; repair of motor vehicles and motorcycles H Transportation and storage,  
I Accommodation and food service activities J Information and communication, K Financial and insurance 
activities, L Real estate activities, M Professional, scientific and technical activities, and N Administrative and 
support service activities. 

The two NACE Rev. 1 sectors B ‘Fishing’ and C ‘Mining and quarrying’ were not included in the calculations of 
1998. They were implemented in the ESAW statistical data from 2008 onwards when NACE 2 was introduced. 
‘Fishing’ is in NACE 2 part of sector A, and ‘Mining and quarrying’ is still sector B.  
B ‘Mining and quarrying’ data are included in those Eurostat statistics about all NACE 2 sectors but not in those 
statistics that explicitly refer to NACE Rev. 2 Sector A, C-N.  In 2019 the fatal accident incident rate of fatal 
accidents in the sector ‘Mining and quarrying’ was five times over the average of all sectors (8.23). 

International data show the comparatively low level of work accidents in the EU. Other countries like 
the United States showed a similar development during this period. 124 While it is estimated that work 
accidents contribute worldwide to 19% of all work-related deaths, this figure is 5% for the EU27. When 
counting DALYs, the work-related injuries account for 17% of all DALYS for injuries and diseases in the 
EU27, and for 29% globally.125  

It is evident that better technical and organisational prevention at workplaces contributed to this 
strong reduction of accidents; prominent examples of such improvements are:   

Technical safer design of moving vehicles, for example, fork lifts, heavy trucks and machines, light 
and noise warning signals for moving vehicles; safer design of machines like automatic shutdowns or 
disconnections, two-hand operating of machines, for example, for pressing and punching, safer cranes 
including better technologies for communication between co-workers, coverage of moving parts, safer 
company cars, for example, safety belts, safer tools, for example, for drilling or cutting; improved PPE 
like  air-supplied  breathing  apparatus,  steel-made  gloves  for  meat  workers,  trousers  that  resist  a 
chainsaw; minimum requirements for buildings, for example, forms and size of stairs and handrails, fire 
exits  and  fire  alarms,  safer  ladders  and  scaffolds, 126  emergency  equipment  like  eye  wash  and 
emergency shower; better monitoring of acute hazards, for example, in sewage water systems, exhaust 
and  ventilation  technologies,  to  avoid  fumes,  dusts,  chemicals  or  contact  with  hazardous  biological 
agents;  strong  safety  obligations  for  work  in  confined  spaces,  work  at  height  and  work  in  trenches; 
introduction of explosion zones and of non-sparking tools, a comprehensive system of warning signals, 
warning  signals  for  slippery  floors  and  unsafe  grounds,  better  warning  systems  and  equipment  in 

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particularly dangerous work environments like road maintenance, combined with better organisational 
measures; quality systems that promote continuous repair and maintenance of tools; regular instructions 
by  safety  representatives  and  safety  coordinators,  and  guarantee  of  minimum  safety  standards  of 
machines and products by European standards like CE and CEE. 

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If  an  accident  takes  place,  the  technical  and  organisational  measures  were  either  not  perfect  for  all 
conceivable  situations  or  not  fully  implemented.  Based  on  ESAW,  Eurostat  analysed  the  physical 
activities per sector that trigger non-fatal and fatal accidents at work in the EU27 (in 2019).127  

Table 14: Accidents at work by physical activity 2019 – Eurostat  

Note: Due to incomplete notifications of the ‘Physical Activity’, the percentages do not sum up to 100%. Also, the 
sums of the numbers are lower than the number of all reported work accidents.  

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Still, not only preventive measures but also other non-OSH-related developments worked in the 
same  direction.  The  shrinkage  of  the  workforce  in  certain  sectors,  for  example,  mining,  textile, 
agriculture, and specific high-risk subsectors of manufacturing, that is, shipyards or foundries, has led 
to a reduction of the workforce in particularly dangerous working conditions. The production of these 
sectors was — partly or fully — relocated to other regions of the world, and EU enterprises import the 
needed products as part of global supply chains.  

Major economic changes of sectors with over average work accident rates 

The decrease of production in the mining and textile sectors was replaced by the import of mining or 
textile products. Nowadays the share of workforce in these sectors is much smaller in the EU than 30 
years ago. In the EU28 in 2019, mining and quarrying employed 392,000 people, or 0.2% of all 
employed persons,128 and the textile industry129 employed 1.5 million people, or 0.7% of all employed 
persons.130  

The share of employees in agriculture, also a sector with high accident rates, dropped mainly due to 
automation from 6.5% in 2005 to 4.5% in 2019131 (worldwide still at 27% 132). In construction, another 
sector with work accident rates over average, the employment is quite stable in the past 25 years and 
fell only from 6.9% to 6.5%. Some specific works with high accident risk have been outsourced to 
other regions, well-known examples are the dangerous shipwrecking but also recycling of plastics and 
electric and electronic devices.133  

The  decline  of  these  sectors  and  the  growth  of  workforce  in  other  sectors  like  wholesale,  transport, 
education, health and care shifted the safety risks of working conditions. Several EU Member States 
also observe a growth of road transport-related accidents during work.134  

4.1.1  Non-fatal work accidents  

DEFINITIONS 
Eurostat has developed the European Statistics on Accidents at Work, or ESAW, methodology to harmonise the 
monitoring of work accidents. This methodology describes how accidents at work have to be reported and defines 
several terms and conditions. 

What is an accident? 

‘Accident at work’ is defined in the ESAW methodology135 as a ‘discrete occurrence in the course of work which 
leads to physical or mental harm.’ 

When is a non-fatal work accident counted? 

ESAW counts a work accident ‘if the resumption of work occurred 5 days after the work accident’; Chapter 4.2 of 
the ESAW Methodology 2012 explains: ‘Accidents at work with more than three calendar days’ absence from work: 
Only  full  calendar  days  of  absence  from  work  have  to  be  considered,  excluding  the  day  of  the  accident. 
Consequently, more than three calendar days’ means “at least four calendar days”, which implies that only if the 
victim resumes work on the fifth (or subsequent) working day after the date on which the accident occurred should 
the incident be included.’ 

Exempted are: Commuting accidents, self-inflicted injuries (e.g. suicides), and strictly natural causes that injure 
people at their workplaces (e.g. earthquakes, floods).  

The total number of reported non-fatal accidents for the EU27 was 3,140,950 in 2019.136 As mentioned 
in the introduction to this chapter, the incident rates of non-fatal accidents fell in about 25 years from 
4,089 (year 1998137) to 1,713 (2019), that is, it decreased about 58%.138 The greatest part of this 
decrease took place between 1998 and 2010,139 the incidence rate halved to 2,021, a drop of 51%. 
Still,  between  2010  and  2019  the  incidence  rate  for  the  EU27  fell  from  2,021 incidents  per  100,000 
workers to 1,713, a drop of a further 15% (taking 2010 as the reference year).140  

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Figure 21: Development of the total number of non-fatal accidents at work and incidence rates (accidents 
per 100,000 workers), 1998 and 2019 – Eurostat 

Still today we can see incident rates above average in sectors like construction and manufacturing, 
wholesale and retail, transport and storage, and agriculture  including forestry and fishing. These  are 
sectors  where  work  with  dangerous  working  conditions  is  quite  common,  that  is,  use  or  handling  of 
heavy or dangerous equipment (sharp, fast, moving, rotating, high-pressure, hot, etc.), work at height, 
work on slippery ground, work with electrical equipment, transport and so on.  

The  ESAW  statistics  demonstrate  that  sectoral  differences  are  still  very  relevant.141 The  sectoral 
incident  rates  differed  between  1,448  for  the  sector  ‘Public  administration,  defence,  and  compulsory 
social security’ (Sector O) and are highest in ‘Construction’ (Sector F) at 3,211. In the period between 
2010 and 2019 the rate for all sectors dropped from 1,799 to 1,603, that is, 11%. The sectoral rates 
developed as follows:  

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Table 15: Incidence rates of non-fatal accidents per sector in 2010 and 2019 (EU27)142 

These  figures  cover  all  employed  persons,  that  is,  employees,  self-employed  with  employees  = 
employers,  self-employed  without  employees  and  contributing  family  member.  Literature  shows  that 
some  categories  of  self-employed  have  higher  accident 
than  employed  worker 
persons.143ESAW data  can  hardly be used for a comparison between self-employed  and other 
groups, because self-employed are in many EU Member States not part of an obligatory work accident 
insurance, but can instead take a choice between obligatory insurance, additional private insurance or 
full  private  insurance. 144 Moreover,  according  to  the  ESAW  regulation,  the  EU  Member  States  can 
decide whether to report work accident data of self-employed to Eurostat or not.145  

rates 

Since the start of ESAW the identification of the level of underreporting was of high importance. 
Periodically,  Eurostat  itself  estimates  underreporting  rates  per  country,  for  example,  in  the  ESAW 
methodology 2001. This is necessary to understand the very different incidence rates in Member States, 
reporting  at  the  lowest  62  (Romania)  and  highest  3,425  (France)  non-fatal  accidents  per  100,000 
employed persons (2019).146 These enormous differences of the occurrence of non-fatal accidents can 
only be explained by different levels of reporting levels and respectively underreporting. 

A quite common method for correcting underreporting is to extrapolate the number of fatal accidents — 
the reporting rate for fatal accidents is regarded as reliable — to calculate non-fatal accidents. Eurostat 
provides the coefficient between fatal and non-fatal accidents.  

Methodology: 
EU-OSHA used the average coefficient between non-fatal and fatal work accidents of the four 
countries Finland, France, Germany and Spain. The coefficient of registered non-fatal accident per 
fatal accident varies between 970 (France) and 2,085 (Germany), in 2019. The coefficient average for 
these four countries is 1,462. If we multiply all ESAW-registered fatal accidents in the EU27 (3,408 
cases) with this coefficient, we end up at 4.98 million non-fatal accidents with more than three days of 
absence. 

For the EU27 in 2019, the average ratio is 922 non-fatal accidents for every fatal accident. 147 For 
an  estimate,  the  coefficients  of  benchmark  countries  with  a  known  high  reporting  rate  are  used  to 
estimate underreporting throughout the EU27.148  

The following table shows the data and the calculation steps. 

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Table 16: Non-fatal accidents estimated via coefficient of fatal accidents, 4 benchmark countries149 

The application of the average coefficient of four benchmark countries to all the EU27 leads to an 
estimated  number  of  non-fatal  accidents  with  more  than  three  days  absence  of  approximately  4.98 
million. This is 1.84 million more work accidents than reported in ESAW; the reporting rate of ESAW 
for non-fatal work accidents with four or more days of absence would be at around 63%. Country-
specific reports about underreporting determine similar figures and support these findings. 150  

There seems to be a difference in the reporting level between countries with a universal health system 
where the reasons for an accident play a minor role and do not impact compensation and treatment. In 
more  fragmented  health  systems  with  distinguished  work  accident  insurances,  the  ‘sphere’  (work  or 
private life) — where the accident took place — is more relevant and influences the granted treatment 
and  compensation.  Some  researchers  perform  this  calculation  only  based  on  the  coefficient  of  two 
countries, Finland and Germany.151 Both have separated insurance-based systems and are regarded 
as  countries  with  a  high  reporting  level.  The  coefficient  would  be  1,734  (average  of  both  countries 
without  weighing  of  population  size);  this  would  result  in  an  estimated  number  of  non-fatal  work 
accidents of 5.91 million. 

Self-reports are another option to identify the number of work accidents. In the Eurostat LFS Ad hoc 
modules of 2007, 2013 and 2020,152 ‘Employed persons’ were asked whether they had a work accident 
in the past 12 months.  

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Table 17: Self-reported work accidents during the last 12 months (EU27) – LFS Ad hoc modules 

Note: In 2020, in total 0.4% responded that they had more than one accident; these data are not available for 2007 
and 2013. 

In 2007, 3.2% of the respondents reported an accident, in 2013 this fell to 2.8%, and in 2020 2.3% of 
the ‘Person in labour force’, aged 15-64, responded with a ‘Yes’. This corresponds to a decline of 28% 
from 2007 to 2020. The decline of the total estimated number of work accidents shows a similar trend, 
a 24% decrease from 5.89 million to 4.46 million (if the persons with more than one accident from the 
2020 survey are not taken into account to achieve a better comparability with 2007 and 2013).  

For 2020, an estimate of the number of accidents based on the Ad hoc module results in a figure 
of  5.24  million.  The  number  of  ESAW-registered  non-fatal  accidents  in  2019  was  3.14  million, 
approximately 60% of the self-reported. One reason for this difference surely is that the respondents to 
the question in the LFS Ad hoc module might refer to every work accident, including those resulting 
in under four days of absence.153  

Estimations  
Eurostat itself estimated in 1999 that approximately 37% of the non-fatal accidents did not need to be 
registered because they resulted in fewer than four days of absence: ‘Around 37% of accidents at work 
in the EU result in fewer than 4 days’ loss of work.’ 154 .In the estimate above the figures are in a similar 
range. The LFS surveys also reveal strong differences between occupational groups. The ISCO 
groups 1-3 have less than half the accidents compared to groups 6-7 and 8-9.155  

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Table 18: People reporting an accident by group of occupations (ISCO) – LFS Ad hoc 2020156 

In the Member States there exist very diverging perceptions of which level of severity of a work 
accident justifies a notification — or in the case of the LFS survey a positive response. In the LFS 
Ad hoc  module  of  2020,  the  figures  vary  significantly  between  Member  States.  Some  countries 
practically report only accidents with ‘Off work’ periods, for example, Italy, Lithuania, Malta and Poland. 
In  other  countries  the  shares  of  work  accidents  reported  that  result  in  ‘Off  work’  are  under  40%,  for 
example, for Sweden and Finland, Greece, Denmark and France. 157 That means that in these countries 
the respondents reported more than 50% such work accidents that did not cause an absence. Cultural 
differences in health perception in society and working life will probably be the major reason for these 
differences. 

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Figure  22:  Share  of  people  reporting  any  accident  and  accidents  resulting  in  time  off  work  by  country, 
2020158 

The statistical analysis did not distinguish between different numbers of days of absence although the 
differentiation was included in the English master questionnaires. The reason given is the wording of 
this question in the national questionnaire; this illustrates the difficulties of surveys at EU level. 159 

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4.1.2  Serious non-fatal and fatal work accidents  

Eurostat defines a fatal work accident as follows: ‘A “fatal accident” means an accident which leads to 
the death of a victim within one year of the accident’.160     
Fatal commuting accidents are excluded, or when counted at national level, excluded from the ESAW 
data.  

In  the  last  decade,  most  EU  Member  States  registered  a  significant  decrease  of  fatal  work 
accidents.161 From 2010 to 2019, for the EU27, the incidence rate of fatal accidents decreased over 
all sectors from 2.31 to 1.74, or a minus of 25%. In the period between 2010 and 2019 the sectoral 
figures of five major sectors developed as follows:  

Table 19: Incidence rates of fatal accidents per sector in 2010 and 2019 (EU27)162 

Also,  large  differences between countries can be noted. The following  figure — taken from the OSH 
Barometer — calculates the number of fatal accidents in periods and compares the period 2010-2014 
with 2015-2020. The reason is that — particularly in smaller Member States — a year with one serious 
and large work accident and several fatalities, or another year without any fatal accident, would distort 
the annual picture and create significant changes from year to year. Romania, Luxembourg and Bulgaria 
have the highest incident rates, and the Netherlands, Sweden and Germany the lowest. In 25 countries 
the rate fell or stagnated in these two periods, with exceptions being Luxembourg and Greece.  

Figure 23: Comparison of the average incidence rate of fatal accidents in two periods: 2010-2014 and 2015-
2020163 

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ESAW  provides  more  detailed  data  about  the  severity  of  non-fatal  accidents. 164  According  to 
Eurostat’s evaluation of ‘Causes and circumstances’ of work accidents (data from 2005, EU-15 and 
Norway), in 2005, 3.9% of the non-fatal work accidents or 157,494 non-fatal accidents led to permanent 
incapacity (full or partly), and 138,568 (3,4% of all accidents) to absences from three to six months. 165  
In 2019, the outcome ‘Permanent incapacity or 183 days (of time-off) or over’ made up 4.4% of all 
non-fatal work accidents or a little more than 100,000 cases. As serious outcomes we regard at 
least the cases in the ESAW category: non-fatal accidents involving these consequences are more than 
34 times more frequent than fatalities. These detailed time-off and outcome data are only available 
for  the  sectors  A  and  C-N,  not  for  the  other  sectors  with  lower  accident  rates.  If  we  include  in  the 
definition of a serious accident also the ESAW category ‘Time off between 3 and 6 months’, another 
5.4% or 129,150 non-fatal accidents would be added to the category ‘Serious accident’.  

This would sum up to 232,892 accidents at work with a time off between three and six months, 
and of more than six months or a permanent handicap.  

Table 20: Severity of accidents in the EU27 in 2019 (sectors A and C-N)166  

National data showed similar coefficients; a calculation for two EU Member States showed a coefficient 
of 27 for Germany (only permanent handicap) and 66 for France. 167 EU-OSHA used the severity data 
of Eurostat in its study on ‘The value of occupational safety and health and the societal costs of work-
related injuries and diseases’ (2019). 168 

According to the publication ‘Causes and circumstances of accidents at work in the EU’ (DG EMPL and 
Eurostat), the types of work accidents causing the longest average days of absence are: ‘Slipping, 
stumbling and falling’ (46 absence days), followed by three more categories at the same level: ‘Loss of 
control of machines or handheld tools’, by ‘Shock, fright, violence, aggression, threat, presence’, 169 and 
by ‘Electrical problems, explosion and fire’ (all three types of accidents with an average of 38 days of 
absence).170  

To conclude, for an estimate of the burden of accidents at work, the distinction between fatal and non-
fatal is too rough. ESAW data allow a finer analysis, at least for the sectors with higher accident 
risks.  The  high  number  of  serious  and  permanent  health  outcomes  cause  human  suffering  and 
significant societal costs; but they play an undervalued role in discussions on work accidents as OSH 
indicators. It has to be mentioned that these data play a large role as indicators in non-European OSH 
systems; Canada uses the Disabling Injury Frequency Rate (DIFR).171 Australia applies incidence and 

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frequency  rates,  which  show  the  incidence  rate  and  frequency  rate  of  long-term  (12  weeks  or  more 
compensation) injury and disease claims.172  

OSH Barometer – Non-fatal accidents at work: 
https://visualisation.osha.europa.eu/osh-barometer/accidents-diseases-well-being/work-
accidents/non-fatal-work-accidents 

OSH Barometer – Fatal accidents at work: 
https://visualisation.osha.europa.eu/osh-barometer/accidents-diseases-well-being/work-
accidents/fatal-work-accidents 

Eurostat – Accidents at work (ESAW and LFS Ad hoc modules): 
https://ec.europa.eu/eurostat/web/health/data/database 

4.2  Trends in health outcomes 

‘The misfortune (harm) that these types of 
workers get from the work in their 
workshops, beyond their uncomfortable 
sitting life, is the threat of Myopia. The 
well-known affection of the eyes, because 
self-evidently for a good visibility it is 
necessary to move the eyes closer to the 
objects of work.’173,174  

Ramazzini, 1713: De Morbis Artificum Diatriba in its 
chapter on ‘Diseases of those who do fine work’. 
Ramazzini’s observation anticipates somehow the 21st 
century knowledge on sedentary work and about 
accommodative fatigue at a near viewing distance. 

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Work-related  health  outcomes  represent  a  much  higher  burden  for  society  than  work 
accidents.175 More workers are affected; the overall costs are much higher. At first glance, the trend of 
health  outcomes  (illnesses  and  wellbeing)  caused  by  ‘exposures’  at  workplaces  is  similarly 
decreasing like the accident trend; that is the case if the scope of the analysis refers to the officially 
recognised occupational diseases.  

The situation is complex, because only few and mostly the recognised occupational diseases have a 
unique cause-effect relationship, that is, a very strong relation between one specific exposure at 
work and one (or more) well-defined disease(s) as a result of this exposure.  
In 1987, a joint ILO/WHO expert committee on occupational health offered the suggestion that the term 
work-related diseases may be appropriate to describe not only recognised occupational diseases but 
other disorders to which the work environment and performance of work contribute significantly as one 
of the several causative factors (Joint ILO/WHO Committee on Occupational Health 1989):  
‘Nevertheless, it is not always that easy to designate a disease as being work-related. In fact, there is a 
wide range of diseases that could be related in one way or another to occupation or working conditions. 
On the one hand, there are the classical diseases that are occupational in nature, generally related to 

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one  causal  agent  and  relatively  easy  to  identify.  On  the  other  hand,  there  are  all  sorts  of  disorders 
without strong or specific connections to occupation and with numerous possible causal agents.’176 

Some  professions  and  regular  work  tasks  had  and  have  very  specific  risks,  for  example,  hearing 
disability through high noise levels, or musculoskeletal diseases caused by permanent repetition of a 
certain movement or posture, or specific cancers after exposure to carcinogenic chemical substances, 
infections in healthcare or work in laboratories, or allergies to natural substances in agriculture. Some 
examples are:  

       Occupation, work task, exposure   
•  healthcare of infected persons    
•  highly repetitive hand and arm movements  
•  quartz dust  
•  working long hours in a kneeling position  
•  extensive UV exposure   
•  aromatic amines  
•  professional musicians    
•  grain dust (agriculture)   

Occupational disease 
► infection with the same disease 
► epicondylitis 
► silicosis 
► bursitis 
► skin cancer 
► bladder cancer 
► focal dystonia  
► allergies, asthma  

Specific  and  strong  connections  between  a  risk  and  an  outcome  (risk  pairs)  are  covered  by 
occupational  disease  recognition  schemes  in  the  EU  Member  States. 177 Some  countries  have 
opening options in their list systems, that is, in principle every disease with a dominant cause in working 
conditions  can  be  recognised.  However,  many  court  cases  about  the  recognition  of  occupational 
diseases demonstrate that a clear cause-effect relationship is not always evident, that is, due to missing 
workplace exposure data from the past or competing causes in private circumstances. All occupational 
diseases with a principally unambiguous relation between cause and consequence account only for a 
small percentage of all work-related diseases.178 

We  can  observe  a  decrease  of  some  of  the  major  recognised  diseases, 179 either  triggered  by 
preventive measures or triggered by shifts of  workforce to sectors with  less recognised occupational 
diseases.  The  new  experimental  EODS  Statistics  of  Eurostat 180  documents  the  following 
developments of recognised occupational diseases.  

Table 21: Development of recognised occupational diseases in the EU 2013-2019  

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Even in the short period between 2013 and 2018 (the period covered by these pilot statistics) the data 
show an overall decline and a decline of several relevant occupational diseases. The strongest decrease 
—  practically  a  halving  —  can  be  seen  for  hearing  impairments  (diseases  of  the  inner  ear). 
Pneumoconiosis, mesothelioma and selected occupational cancers went down between 7% and 14%. 
Asthma  and  some  recognised  MSDs  are  more  or  less  stagnating,  probably  due  to  unchanged 
exposure  to  biological  or  chemical  substances  and  no  change  regarding  the  health  outcomes  of 
ergonomic working conditions. 

If work is one of some causative factors, a clear assignment of work to a health outcome is complex. 
Moreover, in many cases a quite long observation period is necessary simply due to the latency time 
between exposure at work, outbreak and detection of a disease, which is obviously very different 
from the clear and immediate consequence of an accident at work.  

The detection of a disease and the correlation between work and this disease depends highly on the 
monitoring  capacities  of  the  health  system  and  its  ability,  tradition  and  standards  to  connect 
diseases and work-related causes. In a study on ‘Asbestos
related occupational diseases in Central 
and  East  European  Countries’  the  authors  refer  to  different  policies  for  identifying  workers  formerly 
exposed to asbestos and conclude:  

‐

‘Consequently,  large  differences  are  observed  from  one  country  to  another  regarding  the  number  of 
recognised  asbestos-related  cases.  In  Slovenia,  for  example,  the  annual  asbestosis  rate  (cases  of 
asbestosis/population)  amounts  to  14.9,  in  Croatia  5.3,  and  in  Poland  2.1.  Moreover,  in  Estonia,  the 
incidence of asbestosis is unknown as there is no systematic collection of data.’181 

For  example,  until  now  very  few  occupational  diseases  have  been  recognised  as  outcomes  of 
psychosocial risks at work. The ILO proposes in its ‘List of Occupational Diseases Recommendation’ a 
large number of very specific and ‘classic’ occupational diseases — a very broad definition of ‘Mental 
and  behavioural  disorders’  but  leaving  the  responsibility  to  science  and  to  ‘national  conditions’. 182 
Similarly,  the  development  of  the  European  Schedule  of  Occupational  Diseases  (ESOD)  aims  to 
improve  knowledge,  step  up  prevention  and  provide  assistance  in  linking  occupational  activities  and 
diseases. 

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ILO ‘List of Occupational Diseases Recommendation’ 

2.4. Mental and behavioural disorders  

•  2.4.1. Post-traumatic stress disorder 
•  2.4.2. Other mental or behavioural disorders not mentioned in the preceding item where a 
direct link is established scientifically, or determined by methods appropriate to national 
conditions and practice, between the exposure to risk factors arising from work activities and 
the mental and behavioural disorder(s) contracted by the worker 

And there are also emerging and new risks where health data will not be available until a certain 
number of workers are exposed for quite a while. Some prominent examples are nanotechnologies, 
the significant increase of new chemically based technologies, vision impairment due to long hours of 
work under artificial light at the same distance with small digital equipment, 183 more exposure to ‘global’ 
biological  agents  due  to  more  interactional  tasks,  and  travel  and  transport  between  countries  and 
continents.  On  that  note,  the  Covid-19  pandemic  could  also  be  used  as  an  example.  In  2022,  the 
Commission proposed an update of the Recommendation on the ESOD to recognise Covid-19 as an 
occupational disease for workers particularly concerned: health and social care, home help or where 
there is a proven risk of infection (during a pandemic) in other sectors 184. 

It adds to these difficulties that workers are often not only exposed to one disease causing exposure but 
to several exposures at the same time (exposure is understood here in a broad sense: ranging from 
long  working  hours  over  postures  and  movements  to  harassment  and  violence  and  to  noise  and 
chemical and biological substances, etc.). In theory, a single risk — if below the threshold limit values 
and in line with legislation and standards — will not cause harm — given that it is the only exposure. 
The impact of this single exposure is not strong enough to generate a disease on the level of severity 
of a recognised occupational disease. A combination of several risks might add several exposures, 
worsen the impact and cause serious harm.  

Quite well studied is the increased prevalence of musculoskeletal diseases, if not only ergonomic risks 
but also high psychosocial risks are prevalent at the workplace.185 Research has also found unexpected 
connections  like  the  synergistic  effect  of  noise  and  certain  chemicals  on  hearing  impairments.  Such 
outcomes of multi-risk profiles are often particularly difficult to identify and understand. Obviously, most 
sectors and occupations involve workplaces with multi-risk profiles. Some prominent major risks in 
certain sectors or occupations are:  

•  agriculture = accidents, chemical and biological agents, UV exposure;  
•  delivery services = traffic accidents, ergonomics, time pressure, exhaust fumes; 
•  decentralised renewable energy construction and maintenance = falls from height, electricity;  
•  waste and recycling = biological and chemical agents, cuts and accidents;  
•  mobile work = ergonomics, work without time and space limits;  
• 

care  at  home  =  emotional,  ergonomic,  difficult  clients,  unsafe  household  situations,  infection 
risks;  

•  healthcare = emotional, ergonomics, biological;  
•  personal  and  household  services  =  emotional,  ergonomic,  unsafe  household  situations,  e.g. 

• 

• 
• 

unsafe electrical equipment, exposure to unknown chemicals;  
long-haul sea, train, road or air transport = atypical working times, shift work, monotony, long 
phases of physical inactivity;  
car repair = ergonomics, dust and fumes, chemicals;  
construction  =  falls  from  height,  accidents  with  machinery  or  vehicles,  slips,  trips  and  falls, 
ergonomics, noise, chemicals, dust, UV exposure, etc. 

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4.2.1  Statistical picture of mortality and morbidity  

The  development  of  the  overall  health  status  and  its  two  major  indicators  —  mortality  and 
morbidity — is of high relevance for OSH. First of all, these overall ‘Outcome indicators’ cover the whole 
population and can be an indicator for the health impact of working conditions. Secondly, the practical 
OSH  management  has to  react to trends  in  health: this can be the general  ageing of the workforce, 
changing  morbidity  patterns  with  impact  on  the  overall  ability  to  work  and  on  the  practical  work 
organisation,  or  reactions  to  trends  like  physical  inactivity,  overweight  or  the  rapid  growth  of  mental 
diseases.  

In public health, the probably most important and most used statistical indicator is ‘Life expectancy’. 
Life expectancy at EU level has increased steadily for many decades and reached 80.1 years in 2021.186 
It is 82.8 years for women in 2021 and was 81.5 years in 2006; for men it increased from 75.1 years in 
2005 to 77.2 years in 2021.187 It was highest in 2019 at 81.3 and fell by 1.2 years in 2021, mainly due 
to the COVID-19 pandemic.188 

The Eurostat life expectancy statistics clearly document serious differences between EU Member 
States. Southern European countries have the highest life expectancy followed by northern and western 
countries.  Below  average  we  find  those  countries  that  joined  the  EU  in  2004,  for  example,  eastern 
European and Baltic states, and Denmark and Germany.  

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Table 22: Life expectancy by age and sex - in years at the age of 65189  

(bep): break in time series, estimated, provisional, (e): estimated, (p): provisional, (b): break in time series 

The development of life expectancy and causes of lower mortality in the EU are summarised each year 
by the OECD/EU in their joint overview ‘Health at a glance’.190 

‘Steady and substantial reductions in mortality rates from IHD (Ischaemic heart diseases), strokes and 
other circulatory diseases were the main driver of increases in life expectancy in previous decades, but 
these  reductions  have  slowed  down  over  the  past  five  to  ten  years  in  several  Western  European 
countries (e.g. France, Germany and the United Kingdom). This has contributed to the slowdown in life 
expectancy improvements.’ (OECD/The King’s Fund, 2020) 191  

The overview includes the life expectancy of persons at birth and being 65 years old, in the EU plus 
neighbouring countries that report to the EU. The geographical disparities of the life expectancy repeats; 

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people in eastern European and Baltic states have a life expectancy (at the age of 65) of less than 17 
and up to 19.5 years, they all are under the average of 20.0 for the EU28. Some mixed results can be 
observed for Germany, Belgium and Denmark, but clearly southern and northern countries as well as 
France have the highest life expectancy. 

Regarding  mortality  and  morbidity,  in  2019  at  EU27  level  the  main  causes  of  death  were 
cardiovascular diseases plus stroke and ischaemic diseases (35%), cancer (26%), respiratory diseases 
(8%), and accidents and external causes (5%).192  

Figure 24: Main causes of mortality 2019, EU27  

Generally,  academic  literature  groups  the  main  determinants  of  life  expectancy  into  three  main 
categories: resources of the healthcare system, factors related to lifestyle, and socioeconomic 
factors.193 Working conditions are in general regarded as part of the socioeconomic status.  

‘A number of studies have turned to examining within-country health inequalities in order to understand 
population health. One of the first notable studies was the Black Report (Black 1982), which exposed 
staggering  differences  in health across socio-demographic groups in Britain.  Since then,  it  has been 
shown that systematic and persistent health inequalities exist worldwide, whereby individuals with lower 
income, education, and occupational status tend to enjoy considerably worse health.’194 

Due to the difficulty to receive harmonised morbidity and health data from administrative sources of the 
national health systems, European quantitative overviews often rely on surveys that ask for self-
reported health data (Eurostat: Survey on Income and Living Conditions SILC, Eurofound: European 
Quality of Life Survey EQLS, etc.195).  

The  EU  Statistics  on  Income  and  Living  Conditions  (EU-SILC)  corroborate  the  impact  of  the 
socioeconomic  status  for  an  unequal  health  status,  life  expectancy  or  expected  healthy  life  years. 
People with lower income are less likely to report being in good health: 59% of EU citizens in the 
lowest income quintile (the lowest 20%) report being in good health compared to 80% of those in the 

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highest quintile, a difference of 21% (EU27, 2019).196 The European Quality of Life Survey (EQLS) 
finds  that  13%  of  the  lowest  quartile  report  bad  health  (EU28,  2016),  compared  to  only  4%  of  the 
respondents of the highest income quartile. 197  

The relation between socioeconomic status — measured by income — and working conditions 
is  often  not  further  analysed,  at  least  not  on  an  aggregated  statistical  level.  Due  to  complex 
methodological difficulties and strong national variations of the health systems, there are until now no 
EU-wide morbidity statistics available, based on administrative data.198 A ‘Morbidity Task Force’ 
at EU level worked between 2005 and 2011 on the development of such statistics.199 Country-specific 
data — without a harmonised approach between countries — are provided in EU and OECD publication 
series.200  

The system of European Core Health Indicators (ECHI) provides an overview on prevalence of major 
diseases.201 Main  morbidities  covered  until  now  are  asthma,  chronic  obstructive  pulmonary  diseases 
(COPD),  communicable  diseases,  depression,  dementia,  diabetes,  diseases  caused  by  drugs, 
HIV/AIDS, and physical or sensory functional limitations. However, in ECHI there is no option to relate 
these diseases to sectors or occupations.  

The impact of work — as one essential element of the socioeconomic status — on health was the subject 
of numerous academic studies, often performed as specific case studies. The authors of an overview 
study on ‘Cross-country inequality in the EU’ summarise (more references in the original text):  

‘Occupational grade and labour market status are among the factors most often studied in relation to 
health and mortality. Occupational grade has been found to be associated with self-rated health, mental 
and physical health, such as the presence of long-standing illness and a number of diseases. Lower 
occupation  might  affect  health  through  poor  working  conditions,  such  as  the  higher  exposure  to 
occupational  hazards  and  toxic  compounds,  health-damaging  behaviours  and  psychosocial  stress. 
Work-based  stress  combined  with  a  lack  of  autonomy  over  one’s  work  are  believed  to  be  the 
psychosocial factors  that can cause  physiological changes, such as increased risk of cardiovascular 
diseases and reduced immune system response. It has been shown that the gaps in mortality between 
different occupational grades persist in old age and tend to widen with age. 202  

Eurostat provides in the LFS 2020 Ad hoc module on ‘Accidents at work and other work-related health 
problems’  a  rough  overview  on  such  relations,  with  some  specification,  for  example,  for  sectors, 
attainment levels, professional status, size of enterprise or occupation. 203 The differences between four 
aggregated occupational groups and work-related health problems is shown in the next table.  

Table 23:  People  reporting work-related  health problems  by  group  of  occupations (ISCO)  –  LFS  Ad  hoc 
2020204 

9.4% of the group of ‘Managers, professionals, technicians and associate professionals’ and also 9.4% 
of the group of ‘Clerical support workers, service and sales workers’ report work-related health problems, 
2.4% to 4% lower than the two groups with predominantly manual occupations.  

Based on a systematic review of literature on the topic of health factors, a consortium of World Bank 
and Harvard School of Public Health developed for the WHO in the early 1990s a new approach, the 
Global  Burden  of  Disease  (BoD). 205 This  approach  is  meanwhile  used  by  researchers  and  health 
institutes across the globe.206  

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A fundamental element of these disease statistics are the DALYs (DALY = lost life years due to disability 
or in other words: One DALY is one lost year of healthy life).207 These DALYs are a combined value 
of the mortality rate YLL (Years of Life Lost due to premature mortality) and the YLD (Years Lived with 
Disability). DALYs are regarded as a comprehensive and comparable method to measure the health of 
a population. 208 

Based on this framework, the Institute for Health Metrics and Evaluation (IHME)  provides  interactive 
statistical data of the trends and status of risk factors and outcomes (Death and DALYs). These data 
are constantly updated and visualised; the risk factors are: environmental risk, occupational risks (e.g. 
occupational ergonomic factors), behavioural risks (e.g. dietary) and metabolic risks (e.g. high systolic 
blood pressure).209 

4.2.2  Attributable fractions, risk pairs and burden of disease 
As mentioned, for the majority of diseases the working conditions are one  of several influence 
factors  in  combination  with  other  factors  like  private  life,  social  and  medical  system,  genetics, 
environment and so on. The exact impact of this factor, that is, the fraction of disease generating or 
intensifying  impact  attributable  to  work,  is  the  subject  of  numerous  studies  in  occupational 
epidemiology.210  

The  overall  relation  between  work  and  illnesses  is  moving  towards  a  less  unambiguous  picture 
compared to occupational diseases, where a strong relation between a single (over-)exposure and a 
specific  illness  existed.  These  were  mostly  high  exposure  levels  that  could  not  be  found  outside 
workplaces.  Obviously,  many  such  high  exposures  still  exist  and  are  important  for  prevention  and 
compensation.  However,  many  exposures  at  work  approximate  to  other  non-work  exposures,  like 
permanent sedentary work. This makes it more difficult to separate unambiguously the impact of work.  

Science, in particular occupational epidemiology, and institutions like the ILO and WHO studies have 
engaged to identify the approximate impact of work for diseases, the attributable fraction of work.  

For example, the WHO summarised their estimates in the year 2017: 

‘Certain  occupational  risks,  such  as  injuries,  noise,  carcinogenic  agents,  airborne  particles  and 
ergonomic risks account for a substantial part of the burden of chronic diseases: 37% of all cases of 
back pain, 16% of hearing loss, 13% of chronic obstructive pulmonary disease, 11% of asthma, 8% of 
injuries, 9% of lung cancer, 2% of leukaemia and 8% of depression.’211 

One major difficulty surely is the reliable description of exposures at work. Workers might have had 
several occupations during their working life, or changed work tasks in the same occupation due 
to organisational and technological developments, and they might also have changed the specialisation 
in this occupation; also the level of prevention measures differs between sectors and countries. Of 
course, all this influences the exposure patterns. 

EU-OSHA applied in its study on ‘Costs and benefits’ estimates, attributable fractions (AF) based on the 
evaluation of literature  and statistics. The AF vary between  1% for all respiratory diseases,  3.2% for 
neoplasm  and  12.4%  for  circulatory  diseases  up  to  more  than  90%  for  mesothelioma  and  100%  for 
pneumoconiosis.212 For mental diseases the estimated AF is 17.4 % for males and 20.7 for females.213 

There  are  very  clear  connections  between  specific  lung  diseases  (e.g.  pneumoconiosis)  and  work 
because such exposures are often restricted to workplaces, as outside work there is practically no 
exposure; many of these diseases are recognised as occupational diseases. Much less clear are the 
attributions  of  work  to  cardiovascular,  mental,  other  respiratory  diseases  like  asthma  or  COPD,  and 
digestive diseases. 

Lately, the WHO and ILO have made joint efforts to identify the best possible estimates based on the 
systematic  review  of  scientific  literature  on  such  connections.  The  newest  WHO/ILO  review  of  risk 
pairs 214 identified  several  significant  relations  between  specific  risks  of  work  conditions  and  related 
diseases,  for  example,  long  working  hours  and  stroke,  or  exposure  to  particulate  matter,  gases  and 
chronic obstructive pulmonary diseases. For some specific chemicals and metals, the AF is very low 
because other exposures — nutrition, environment — might have a much bigger impact than workplace 

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exposures. The WHO/ILO study estimated the highest AF for the risk pair asbestos and mesothelioma, 
for occupational ergonomic factors and back and neck pain, and for some types of occupational injuries. 

Table 24: Examples of fractions of diseases attributable to work (AF) – WHO/ILO215 

In 2021, the WHO and ILO published their estimates of the burden of work-related diseases, named the 
‘WHO/ILO  joint  estimates  of  the  work-related  burden  of  disease  and  injury,  2000-2016’.216 WHO/ILO 
calculates for the EU27 114,000 work-related deaths per year in 2016. When setting the absolute 
number  of  work-related  deaths  (114,000)  in  relation  to  the  EU27  population  above  16  years  (371 
million) in 2016, this results in approximately 31 deaths per 100,000 population in working age above 
16 years.217  

The  second  reference  estimate  was  provided  by  the  International  Commission  on  Occupational 
Health (ICOH). The size of the two major health consequences (‘Outcomes’) was calculated, that is, 
work-related deaths, and work-related diseases. ICOH estimates in total 179,000 deaths; moreover, 
they  refer  to  the  much  smaller  labour  force  population  (209  million)  and  calculate  89  work-related 
deaths  per  100,000  labour  force.  The  main  reason  for  these  different  estimates  is  the  general 
approach: WHO/ILO restricts their analysis to selected risk-outcome pairs, for example, long working 
hours as risk and stroke as outcome, whereas ICOH aspired to cover all work-related diseases. 

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Figure 25: Work-related deaths – estimates by WHO/ILO218 and ICOH219 for EU27 

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The figure below displays the relation between major risks and the health outcome in DALYs. The 
estimates of DALYS that are attributable to work vary between 6.8 million years (ICOH) and 4.4 million 
years (WHO/ILO), both for the EU27.  

Figure 26: Work-related DALYs – estimates by WHO/ILO and ICOH for the EU27  

Putting the absolute numbers of WHO/ILO in relation to the EU27 population above 16 years this results 
in  approximately  1,172  lost  life  years  per  100,000  working-age  population  (WHO/ILO).  ICOH 
calculates  in  absolute  numbers  6.8  million  lost  life  years  for  the  labour  force  population,  resulting  in 
3,364 DALYs per 100,000 labour force. 

It can be concluded that despite methodological differences the estimates do not vary that much if the 
same  reference  population  is  used  in  the  calculation.  Future  research  will  contribute  to  a  better 
attribution of the impact of  work on these diseases. In the future, relevant disease groups will be 
incorporated in these estimates, that is, the impact of work on the prevalence of mental diseases 
and of communicable diseases caused by biological agents needs to be incorporated.  

The  next  table  shows  the  difference  between  major  occupational  risk  factors  and  deaths  at  the 
EU27 level and the global level. At EU27 level asbestos-related cancers are clearly the most frequent 
reason for work-related deaths with nearly 60% of all cases; the two next main causes are COPD (15.9%) 
and CVD (12.3%). The global situation is quite different. CVD account for nearly 40%, COPD for 24% 
and injuries for 19%.  

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Table 25: Summary Burden of diseases EU27, Global deaths – WHO/ILO 2016220,221 

The global number of deaths per 100,000 population (≥ age 15) is 34.7 cases, and for the EU27 it is at 
a level of 30.7 cases per 100,000 (≥ age 16).222 

The  next  table  displays  the  relation  between  major  work-related  risks  and  the  health  outcome 
measured in DALYs at a European and a global level. Asbestos-related cancers account for the highest 
share of more than 29% (1,269,143 DALYs); the second and third largest group of diseases are back 
and  neck  pain  and  work-related  injuries.  At  a  global  level,  injuries  dominate  (29.4%),  followed  by 
cardiovascular diseases (25.9%), and back and neck pain (13.7%). The data for the EU27 and ‘Global’ 
look quite similar for hearing loss and asthma. The global number of DALYs per 100,000 population (≥ 
age 15) is 1,657, for the EU27 it is at a level of 1,172 cases per 100,000. 

Table 26: Summary Burden of diseases table DALYs WHO/ILO223 

The differences for this deviation between the EU27 and the global situation will be the subject of 
future research and analysis. It can be assumed that different working conditions and a different level 
of  prevention  measures  are  important  factors.  A  crucial  factor  is  the  monitoring  capacity,  that  is,  the 
ability — and/or obligation — of the health system to identify and register work-related diseases, and 
the publication of reliable and well accessible statistics.  

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ICOH used for its estimates more risk factors, different disease categories and different values of 
AF. This methodology results in significantly higher figures for CVD and other diseases.  

The same applies for DALYs; WHO/ILO estimates sum up to approximately 63% of the ICOH values. 
The main difference is due to the approximately 2.3 million DALYs that ICOH calculated for other work-
related  diseases.  WHO/ILO  applied  strict  methodological  criteria  and  consequently  excluded  quite  a 
large number of studies as a base for their estimates. They write: 

‘Third, it must be noted that not all occupational risk factors and attributable burdens of disease have 
yet been quantified. The production of estimates for some pairs was not possible in this estimation cycle, 
such as: occupational exposure to biological risk factors and infectious diseases; occupational exposure 
to  psycho-social  risk  factors  and  mental  health  outcomes;  and  occupational  exposure  to  ambient  air 
pollution and its various health outcomes. Further, while there are established methods for estimating 
the  burdens  of  silicosis,  asbestosis,  coal  worker’s  pneumoconiosis  and  unspecified  pneumoconiosis 
attributable  to  occupational  exposure  to  dusts  and  fibers,  WHO  and  the  ILO  are  currently  reviewing 
these methods and the available bodies of evidence (10); these pairs were therefore not included in this 
estimation cycle. While this means that the work-related burden of disease is almost certainly higher 
than the current estimate of selected pairs, the addition of such pairs in future will broaden the scope 
of these estimates and capture the work-related burden of disease more comprehensively.’224 

All estimates depend on good monitoring capacities of the health system but also on reliable quantitative 
overviews  of  exposure  situations  at  workplaces.  In  research  and  monitoring  of  occupational  cancer 
some  quantitative  overviews  on  such  exposures  have  been  established  (see  for  example,  CAREX 
Finland, its follow-up projects, e.g. in Canada, and the many approaches for exposure assessments).225 
One of the reasons for the establishment of a clear relation between long working hours and stroke is 
the  comparatively  excellent  data  situation  concerning  working  hours  and  long  working  hours  in 
combination with administrative health data about stroke.  

4.2.3  Examples of specific prevalence estimates  
The methodologies to estimate the burden of diseases have been developed over the past 30 years. In 
the coming years we can expect that research will contribute to more precise estimates of the work-
related share of the burden of the diseases.  

Very probably mental health and biological agents will be fully incorporated in such estimates, 
and research will contribute to better explanations, for example, of the work-related prevalence of MSDs. 
Two  groups  of  diseases  examples  —  mental  health  and  musculoskeletal  diseases  —  are  briefly 
presented in this chapter.  

The first ‘Global Burden of Disease’ study (1996, the study was the breakthrough for the concept of 
DALYs)  is  quite  astonishing.  Already  then,  the  authors  complained  that  the  ‘burden  of  psychiatric 
conditions  has  been  heavily  underestimated’.  In  their  estimation  of  the  globally  leading  causes  of 
disability they put four psychiatric conditions under the first 10: 

•  Unipolar major depression – 10.7% (of all causes) 
•  Bipolar disorders – 3.0% (of all causes) 
•  Schizophrenia – 2.6% (of all causes) 
•  Obsessive-compulsive disorders – 2.2% (of all causes) 

The data of the first overview (based on data from 1990) were updated in 2019 and show an even worse 
picture:  

‘From 1990 to 2019, the global number of DALYs due to mental disorders increased from 80.8 million 
to  125.3  million,  ….  Age-standardised  DALY  rates  remained  largely  consistent  between  1990 
(1581·DALYs  per  100,000  population)  and  2019  (1566  DALYs  per  100,000  population).  YLDs 226 
contributed to almost all of the mental disorder burden, accounting for 125.3 million YLDs or 14.6% of 
global YLDs in 2019.’227  

In 2019 the WHO stated that one in every eight people, or 970 million people around the world, were 

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living  with  a  mental  disorder,  with  anxiety  and  depressive  disorders  being  the  most  common.228 The 
OECD  estimates  that  approximately  one-third  of  all  disability  benefits  is  due  to  these  groups  of 
diseases.229  

WHO definition of mental health from 2001: ‘Mental health is a state of well-being in which the 
individual realises his or her own abilities, can cope with the normal stresses of life, can work 
productively and fruitfully and is able to make a contribution to his or her community’. 

ICD 11 (06) Mental, behavioural or neurodevelopmental disorders: ‘Neurodevelopmental 
disorders / Schizophrenia or other primary psychotic disorders / Catatonia / Mood disorders / Anxiety 
or fear-related disorders / Obsessive-compulsive or related disorders / Disorders specifically 
associated with stress / Dissociative disorders / Feeding or eating disorders / Elimination disorders / 
Disorders of bodily distress or bodily experience / Disorders due to substance use or addictive 
behaviours / Impulse control disorders / Disruptive behaviour or dissocial disorders / Personality 
disorders and related traits / Paraphilic disorders / Factitious disorders / Neurocognitive disorders / 
Mental or behavioural disorders associated with pregnancy, childbirth or the puerperium.’ 

The  cost  factor  is  enormous;  the  OECD  and  European  Commission  estimated  that  the  overall 
financial costs of mental disorders, including direct medical as well as indirect costs through care 
and lost productivity, amount to more than €600 billion per year in the EU 230 (see also Andlin-Sobocki 
et al. (2005)231). ICOH has started to integrate the newest estimates of mental health disorders with the 
AF (based on Niedhammer et al.232). The first calculations result in 7.5 million DALYS for the EU27, for 
work-related job strain, depression and resulting cardiovascular diseases (all other diseases 6.9 million). 
The  strong  rise  in  ‘Mental  and  behavioural  disorders’  as  a  reason  for  absence  from  work  or  early 
pensions surely contributes to this change.233 EU and global institutions have started several long-term 
policies and actions on mental health, for example, the EU Framework for Action on Mental Health and 
Wellbeing.234  

The  term  ‘Musculoskeletal  diseases’  covers  the  most  common  group  of  diseases  (ICD  11-15 
‘Diseases  of  the  musculoskeletal  system  or  connected  tissue’).235 These  diseases  have  the  highest 
prevalence, approximately 60% of the EU working population report one or several MSDs. 236 MSDs that 
are caused or made worse by work can be defined as work-related MSDs.237 Work-related MSDs arise 
from regular exposure to a certain posture or workload. It is a problem that affects all forms of working 
environments, from physically arduous work to low-intensity static work.238  

Moreover, the prevalence of MSDs is not decreasing, as could be expected due to the sectoral shifts 
of workforce from industry and agriculture to services. The authors of the EU-OSHA study ‘Work-related 
musculoskeletal  disorders:  why  are  they  still  so  prevalent?’  consider  several  reasons  for  this:  the 
ergonomic burden shifted to other tasks, for example, handling of patients instead of handling of heavy 
loads,  more  inactivity  with  other  musculoskeletal  consequences,  more  time  pressure,  an  ageing 
workforce, and inadequate work organisation and contractual arrangements. 239  

The tremendous shift of workforce to administrative and often digitalised work contributes to an increase 
of the number of workers suffering from the consequences of physical inactivity due to permanent 
sedentary work, mostly with digital equipment. The figure below shows the spread of these diseases 
in different occupations.240  

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Figure 27: Prevalence of musculoskeletal diseases – EWCS 2015  

Absence from work due to MSDs accounts for a high proportion of working days lost in EU Member 
States. In 2015, more than half (53%) of workers with MSDs (including those with other health problems) 
reported being absent from work during the past year, which is considerably higher than the proportion 
of workers without health problems (32%). Workers with MSDs are not only more likely to be absent 
from work, but (given absence) on average are also absent for a longer period. For example, 26% of 
workers with chronic MSDs and other health  problems report being absent for  more than  eight  days 
during the past year, which is considerably higher than the 7% for workers with no health problems. 241 

Overall estimates of the burden of MSDs for the EU27 seem to be difficult, due to different recognition 
and treatment schemes.242 The estimates of WHO/ILO and ICOH result in 850,000 and 950,000 DALYs 
for the EU27, based on a fraction of 26.38% attributable to work; in total, MSDs are the cause of 15-20% 
of all DALYs. 

OSH Barometer – Accidents, diseases and wellbeing – Diseases:  
https://visualisation.osha.europa.eu/osh-barometer/osh-outcomes/work-related-diseases/who-
ilo/prevalence-of-diseases/all-diseases 

Eurostat – Data and databases on health: 
https://ec.europa.eu/eurostat/web/health/data/database 

WHO – Occupational Burden of Disease Application: 
https://who-ilo-joint-estimates.shinyapps.io/OccupationalBurdenOfDisease/ 

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4.3  Wellbeing and health status  
Existing concepts of wellbeing cover more aspects of work than working conditions or safety and 
health  at  workplaces.  Eurofound  mentions  as  the  most  relevant  components:  income,  working  time 
arrangements, possibilities for skills development and career advancement, and the degree of individual 
control  over  work. 243 The  United  Nations  Economic  Commission  for  Europe  (UNECE)  developed  a 
scheme of quality of employment that covers these aspects: safety and ethics of employment, income 
benefits  and  employment,  working  hours  and  balancing  working  and  non-working  life,  security  of 
employment  and  social  protection,  social  dialogue,  skills  development  and  training,  workplace 
relationships and work motivation.244  

This chapter focuses on the health and safety aspects of wellbeing, although the OSH aspect is often 
not clearly separable from the above-mentioned aspects, that is, when surveys are intending to identify 
the level of ‘satisfaction at work’. Still, due to its serious impact on all other aspects of working conditions, 
the consequences of insufficient health are regarded as critical: 

‘While OHS is only one substantive working condition, like earnings and job insecurity it is arguably a 
critical one for many workers. In terms of scope and severity, even official data … suggests poor OHS 
is something most workers will experience at some point and many far more frequently.’245 

A  common  methodology  to  collect  data  on  health  status  and  wellbeing  is  self-reporting  and  self-
assessment of workplace risks, health risks and health problems, absence, job satisfaction and working 
life perspective from a health point of view. The data are in general collected by EU-wide surveys, for 
example,  by  the  EWCS,  the  Flash  Eurobarometer,  ESENER  or  the  LFS  Ad hoc  modules.  The 
description of working conditions in the OSH Barometer starts with responses regarding the ‘Overall 
opinion’  on  working  conditions.  This  allows  insight  into  the  subjective  assessment  of  health  risks  at 
work and wellbeing.  

4.3.1  Satisfaction at work  

In the EWCS of 2015, at EU level 86% of the workers respond that they are ‘satisfied’ (60%) or ‘very 
satisfied’ (26%) with their work. Country differences exist but are not striking. The EU Member States 
with the highest satisfaction rates are Austria, the Netherlands, Finland, Czechia, Denmark, Belgium 
and Estonia; they range between 93% and 90%. The six countries with the lowest sum of satisfied and 
very  satisfied  responses  are  Greece,  Croatia,  France,  Spain,  Italy  and  Latvia;  their  values  range 
between 77% and 82%. 

Figure 28: Satisfaction with working conditions in the main paid job – EWCS 2015246 

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These EWCS findings are approximately in line with the results of the Flash Eurobarometer from 2014 
where 77% of the workers respond that they are overall satisfied with working conditions and 85% 
that they are satisfied with health and safety. In the Flash Eurobarometer for responses to the specific 
question on satisfaction with health and safety at work (see next figure), Austria, the Netherlands, 
Belgium, Ireland, Denmark, Finland and Estonia are the top seven countries with the highest satisfaction 
rates.  Cyprus,  France,  Croatia,  Romania,  Spain,  Latvia  and  Greece  form  the  group  of  the  seven 
countries with the lowest satisfaction rates.247 

Figure 29: Flash Eurobarometer 2014 – Satisfaction with health and safety at work248    

In 2005, just after the accession of  10  new  EU Member States, the average  EU level was  slightly 
different, four percentage points lower at 82%249 (EWCS, 2005). In that year, the six EU Member 
States with the highest rates of satisfaction were Denmark, Austria, Belgium, Germany, the Netherlands 
and Luxembourg (all around 90%). The lowest degree of satisfaction was reported by the workers of 
Romania (not an EU member at that time), Greece, Bulgaria (not an EU member at that time), Lithuania, 
Latvia and Slovenia, significantly lower than today, between 58% and 72%.  

The most visible change is that in 2005 the lowest degree of satisfaction was exclusively reported in 
south-eastern European countries and the Baltics. In 2015, three southern and south-western EU 
Member  States,  that  is,  France,  Italy  and  Spain,  were  part  of  the  six  countries  with  the  lowest 
satisfaction  rate,  while  the  states  from  south-eastern  Europe  and  the  Baltic  states  showed  low  but 
increased satisfaction rates.  

In  2015,  the  percentage  of  workers  who  responded  to  be  ‘unsatisfied’  or  ‘very  unsatisfied’  is 
characterised by the following patterns:250  

•  Sectoral:  the  highest  rates  of  dissatisfaction  were  reported  in  the  three  sectors  agriculture, 

hotels and restaurants, and manufacturing.  

•  Level of education: 51% of workers with third-level degree (ISCED 5 or 6) 251 report being ‘very 

satisfied’ compared to an average of 25% for the whole sample.  

•  Less differences can be seen for the form of work, that is, those with a permanent contract and 

those with ‘Other arrangements’.  

Age and gender have a minor influence on responses to the question on job satisfaction. 

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4.3.2  Health affected – overall opinion  
The self-assessment of health risks at work is a question in the EWCS. According to the responses to 
the EWCS 2015, work is regarded by exactly one-quarter (25%) of the workers in the EU as a health 
risk. (The OSH Barometer provides more details; links in the text box at the end of this chapter.)  

The countries with the lowest percentage of perceived affection of health at work are Portugal at 
15%; below or around 20% are also Italy, Ireland and Czechia, Germany, Hungary and Romania. The 
countries with the highest percentage of perceived health risks at work are Latvia (41%), followed by 
Spain and Slovenia (both 38%), Lithuania (37%), and Estonia, France and Malta (all 35%). 

At EU level the aggregated sectors ‘Construction and Transport’ show the highest figures (35%) and 
‘Commerce  /  Hospitality’  (20%)  and  ‘Financial  /  Other  services’  the  lowest  (20%).  These  sectoral 
differences repeat in most countries.  

Figure 30: ‘Health at risk’, sectoral responses for EU and three countries – EWCS 2015252    

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Regarding  this  question,  age  differences  are  negligible.  Concerning  gender,  male  respondents 
report more often that their work imposes health risks; at EU level the values are 23% for female workers 
and 27% for male workers.  

In  2005,  the  workers  in  the  10  new  Member  States  responded  much  less  positive;  40%  of  the 
workers in the 10 new Member States considered their health and safety to be affected because of their 
work.  

Figure 31: ‘Health at risk’, responses in groups of EU Member States – EWCS253  

For the EU-15 (Member States that joined the EU before 2004), the ‘Yes’ responses to this question 
decreased from 31% in 1991 (first EWCS) to 28% in 2005 and reached 26% in 2015. For the 10 new 
Member States the rate decreased, from previously 40% in 2005 to 29% in 2015.254 The EU membership 
has definitely created more convergence between the countries. 

4.3.3  Reported health problems 
The identification of current work-related health problems is another approach to create an indicator 
for health status. Eurostat collected this data in the LFS Ad hoc modules 2007, 2013 and 2020, Persons 
reporting a work-related health problem by sex, age and NACE Rev. 2 activity.255  

In 2007, 14.6% of employed persons reported a work-related health problem; this figure decreased 
in 2013 to 8.8% and went up again to 10.3% in 2020 256 (EU27 level). As expected, age is one of the 
factors that influence the response to this question. In 2020, 14.1% of the workers in age class 55-64 
years reported a work-related health problem, compared to 6.5% in age class 15-34 years and 10.8 in 
age class 35-54 years. These differences between the age classes were quite similar in all three points 
of time. 

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Figure 32: Age classes and work-related health problems in 2007, 2013, 2020 – LFS ad hoc module 

When looking at the differences between countries in 2020, the countries with the highest values are: 
Poland  (36.6%),  Finland  (25.7%)  and  Sweden  (20.3%);  all  three  are  far  above  the  average.  Austria, 
Luxembourg and Germany have figures close to the EU27 average of 10.3%. In most other countries 
the  response  values  are  under  or  close  to  6%,  like  in  Estonia,  Romania,  Ireland,  Latvia,  Lithuania, 
Hungary, Malta, Bulgaria, Greece, Croatia, Cyprus, Czechia and Slovenia.257  

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Figure  33:  People  reporting  a  work-related  health  problem  and  People  reporting  a  work-related  health 
problem causing daily limitations 2020 – LFS Ad hoc module 2020  

These responses are probably very much influenced by occupational, sector and country-specific 
cultures of defining and expressing a health problem and a different opinion on the job. It is clearly 
not realistic that workers in Poland or Sweden suffer 10 times more often from a work-related health 
problem than workers in Ireland or Romania. Suppression or resistance to express a health problem 
might be one cause for such low figures for countries with a high degree of manual work, be it highly or 
low skilled.258 It might also be that a high awareness of health issues — not only caused by the risk but 
also by the necessary prevention measures — results in high response values for both questions, that 
is,  high  awareness  of  risks  might  be  the  cause  for  well-developed  prevention  measures  and 

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result in high values for both responses. That is, high risk but also high satisfaction with health 
and safety.  

The picture of country positions in this ranking changes again when looking at the response on the off-
work  periods  due  to  a  work-related  health  problem.259 In  2020,  around  10%  report  that  they  had  a 
work-related health problem that kept them more than six months away from work. The rate is at 
10.1% for the EU27; the countries with the highest rates above 20% are Hungary (30.3%), Lithuania 
(29.9%), the Netherlands (27.6%), Belgium (20.9%) and Romania (20.7%). The countries with lowest 
rates  under  10%  are  Poland  (2.6%),  Denmark  (6.0%),  Sweden  (6.2%),  Italy  (6.5%)  and  Finland 
(9.0%).260 The  country  positions  do  not  change  much  when  looking  at  all  absences  over  one  month 
(18.7% for the EU), or three months or over (12.6% for the EU27).261 That means that — at least at 
the first glance contradictory — countries reporting highest health risks have the lowest number 
of  long-term  off-work  periods.  These  figures  are  probably  much  influenced  by  social  security  and 
compensation rules. This is another indication that high exposure and identification of health risks 
— fortunately — does not materialise in serious disease episodes, and this could be attributed 
to on the effectiveness of prevention measures. 

There might also be structural reasons for low levels of reported health problems, for example, a high 
percentage of young workers with low illness rates in highly skilled clerical work; Ireland is probably 
such an example.  

The responses to ‘work-related health problem’ vary also between different occupational groups. 262 
The  skilled  agricultural  and  fishery  workers  (16.9%)  report  the  highest  values,  followed  by  plant  and 
machine operators and assemblers (12.5%), craft and related trades workers (12.3%), and the group of 
those with elementary occupations (11.2%). The lowest shares were found for the professionals (9.3%), 
legislators, senior officials and managers (9.0%), and clerks (8.0%).  

Figure 34: People reporting a work-related health problem by occupational category 2020  – LFS Ad hoc 
module 2020  

These  differences  between  occupational  groups  are  not  surprising;  they  repeat  the  results  of  other 
studies, statistics and surveys where manual workers show higher levels of illness / morbidity. 

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4.3.4  Working life perspective – health 
This EWCS 2015 question on the working life perspective (‘Will you be able to do this or a similar job 
at 60 years of age?’) gives quite a good hint to the individual long-term prospects, which might even be 
more valuable than the question on currently affected health because it is a personal assessment of the 
overall status of health. 

Differences between countries are significant but not as significant as between other categories, 
for example, between sectors and occupations. The EU average of ‘No’ responses to the question 
‘Do you think you will be able to do your current job or a similar one until you are 60 years old?’ is at 
27%; the eight countries with the highest rates of ‘No’ responses (between 44% and 33%) are France, 
Slovenia, Poland, Slovakia, Croatia, Belgium, Malta and Bulgaria. Under 25% of ‘No’ responses were 
given in eight countries, starting from Portugal (16%) over Germany, Denmark, Ireland, Sweden, Italy, 
Estonia and Lithuania (24%).263 

Figure 35: Opinion on work until the age of 60 – EWCS 2015  

Young workers under 35 are much more sceptic than those over 50; 38% say that they will not be 
able, a much higher percentage than the 22% of workers aged over 50. The employment status is also 
very important; 26% of the permanently employed respond with a ‘No’ compared to 39% of those with 
‘Other arrangements’. Remarkably, only 19% of the self-employed do not believe that they will be able 
to do their job at 60 years.  

Large differences can be seen between occupation levels. 37% per cent of the low-skilled manual 
workers respond with ‘No’, and 30% of the highly skilled manual workers respond ‘No’, as do 27% of 
the  low-skilled  clerical  workers  and  only  21%  of  the  high-skilled  clerical  workers,  a  16%  difference 
between high-skilled clerical workers and low-skilled manual workers. In some countries only 10% to 
15% of the highly skilled clerical workers respond with ‘No’ while in a number of countries more than 
50% of the low-skilled manual workers respond with ‘No’, for example, in Slovenia, Croatia, Slovakia 
and Czechia. 

The authors of the Senior Working Life study describe these differences as follows:264 

‘For ISCO groups 1–4 (seated work) main expected reasons for retiring were freedom to choose and 
desire for more leisure time, but many would consider staying longer if there were better possibilities for 
additional  senior  days,  longer  vacations  and  flexible  working  hours.  For  ISCO  groups  5–9  (physical 
work), poor physical health and not being capable of doing the job were common expected reasons for 
retiring, but many would consider staying longer if the work were less physically demanding and there 
were more senior days.  Possibility for pension was  a  general expected reason for retiring.  Expected 
reasons differed to a less extent between genders than between ISCO groups, e.g. economic factors 
were more important for men and high work demands more important for women. 

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The  strong  differences  in  the  expectations  to  do  the  job  until  60  years  of  age  are  probably  also 
caused  by  the  circumstance  that  the  labour  market  for  physically  demanding  jobs  is  more  rigid.  For 
example,  one  serious  musculoskeletal  issue  might  mean  being  out  of  a  manual  job  far  before  the 
pension age. For diseases caused by excessive psychosocial burden, other difficulties can be observed: 
the  recognition  as  work-related  is  less  accepted,  work-related  and  private  life  causes  are  closely 
intertwined, and the diagnosis can be difficult.  

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4.3.5  Summary of survey results on wellbeing and health status  

An overview table on the responses to five questions in three different surveys reveals partly consistent 
and partly contradictory results per country. There are countries that have a consistent outcome over all 
questions, while others show a mixed or contradictory picture. 

Figure  36:  Comparison  of  responses  to  self-rated  work  satisfaction,  health  risks  and  working  life 
perspectives – Flash Eurobarometer, LFS and EWCS 

Values better than 25% of EU average are marked in aquamarine, and values worse than 25% of EU average in 
orange. Other values are not marked. 

Denmark, Czechia, Italy and Luxembourg are the countries over or at average for every item.  Some 
countries are mostly at average, or have a negative result for one item, often the period off work or low 

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satisfaction,  for  example,  Austria,  Cyprus,  Germany,  Greece,  Ireland,  Hungary,  the  Netherlands, 
Portugal and Slovakia. The one negative item might also be work-related health problems, for example, 
for Sweden and Finland.  

Most countries show more extreme contradictions, that is, being in some aspects better and in others 
worse than average, like Estonia, Lithuania, Poland, Bulgaria, Portugal, Slovenia and Spain. Many of 
these  countries  have  very  low  figures  for  work-related  health  problems.  Contradictory  but  mostly 
negative responses (two or three fields with values under average) we find for Austria, Belgium, Croatia, 
France, Latvia, Lithuania, Malta, Romania, Poland, Spain and Slovenia. 

4.4  Conclusions  
Work accident data — fatal and non-fatal — show an impressive decline in the past 20 years, even if 
one takes into account the significant level of underreporting. Preventive technical and organisational 
safety measures and sectoral shifts were the crucial factors for this improvement. The relevance of non-
fatal accidents with severe health consequences — permanent disability or more than three months’ 
time-off period (more than 230,000) — should be recognised and further investigated.  

Public health data show a significant increase in life expectancy and substantial shifts in morbidity 
during the past three decades at EU level, also documenting major differences between EU Member 
States in mortality and morbidity. Socioeconomic inequality is an evident reason for higher mortality 
and morbidity. There is less evidence concerning the correlation between working conditions — as a 
major element of the socioeconomic status — and mortality and morbidity at EU level.  

The  clearest  evidence  on  the  relationship  between  working  conditions  and  diseases  exists  for 
recognised occupational diseases, and for these, the trend is also strongly downwards. In contrast, the 
estimates of the development of work-related diseases — based on fractions of diseases attributable 
to work occupation — show a persistently high burden. The current estimates of ILO/WHO and of ICOH 
range between 115,000 and 180,000 deaths and between 4.5 million and 6.9 million DALYs; advanced 
research and the incorporation of more disease groups — mental health, diseases caused by biological 
agents — will significantly increase these figures. Literature, studies and surveys like the EWCS, LFS 
and the Flash Eurobarometer clearly show the strong relations between health status and occupation. 
Eurostat  works  on  improvements  concerning  the  morbidity  statistics  (task  force,  pilot  statistics  on 
occupational  diseases).  EU-wide  morbidity  statistics  from  national  administrative  sources  might  be 
available in the future; currently self-reported health data are the major source for EU-wide harmonised 
quantitative data.  

Wellbeing  and  satisfaction  at  work  show  similar  patterns  as  health  and  work  accidents  and  work-
related health issues. Sectors with high physical demands and high customer and client orientation and 
occupations with a lower skill level report lower wellbeing and satisfaction levels; these groups report a 
good  health  status  —  mostly  being  younger  —  but  fewer  expectations  to  be  able  to  work  in  this 
occupation until the age of 60. Professions with strong customer and client orientation have lower-than-
average wellbeing and satisfaction rates. 

Workers  in  manual  occupations 265  have  higher  accident  rates,  lower  life  expectancy  and  less 
expectancy to do the job until age 60. Administrative workers (clerical, managerial) have a better 
status in the above-mentioned aspects but report a worse health situation. For many items the eastern 
EU Member States — often all of them — report the least positive data. The healthy worker effect and 
cultural differences — to express not being healthy — probably strongly influence the self-assessment.  

Concerning  the  levels  of  self-reported  ‘Health  at  risk’,  the  comparison  between  2005  and  2015 
suggests that the situation has slightly improved for all EU Member States; sector differences remain 
significant, but the East-West divide has become much smaller. Still, in some respect eastern and some 
southern  European  countries  show  worse  data  compared  to  central/western  and  northern  European 
countries. 

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Overall,  when  looking  at  all  the  quantitative  indicators  we  find  a  strong  influence  of  sector, 
professional status and occupation on the level of accidents, of work-related diseases, and the 
status  of  health  and  wellbeing  —  and  for  some  data  serious  differences  between  countries  or 
groups of countries.  

OSH Barometer – Working conditions, Health perception of the workers, Health problems in the 
https://visualisation.osha.europa.eu/osh-barometer/accidents-diseases-well-
12  months: 
last 
being/health-perception 

OSH  Barometer  –  Working  conditions,  Working  conditions,  Overall  opinion,  Health  at  risk:  
https://visualisation.osha.europa.eu/osh-barometer/working-conditions-preventions/overall-
opinion/health-at-risk 

OSH  Barometer  –  Working  conditions,  Overall  opinion,  Satisfaction  with  Health  and  Safety: 
https://visualisation.osha.europa.eu/osh-barometer/working-conditions-preventions/overall-
opinion/satisfaction-health-safety  

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5  Major context developments and their influence on 

working conditions 

In many cases, one can find overwhelming evidence about ‘structural’ trends and developments 
that influence OSH at workplaces. For example, looking at the data there can be no doubt that the EU 
population  and  workforce  is  ageing,  there  can  be  no  doubt  about  the  decline  of  workforce  in  certain 
sectors and growth in others, there can be no doubt that education is longer, skills are higher and work 
life starts later.  

Still,  in  many  cases  the  available  data  lack  a  sufficient  level  of  reliability,  the  data  from  different 
sources  are  contradictory  or  ambiguous,  and  the  hypotheses  about  the  reasons  for  findings  differ. 
Consequently, the influence is either not clear or definitely ambiguous in its impact on OSH, as often 
holds in the case of new technologies. For reasons of readability and size of this report, we exclude a 
detailed description of some context factors, for example, the development of industrial relations, labour 
law and social security legislation, or public health policies.  

The chapter focuses on four major  context factors:  changes from industrial  to service sectors, 
technological developments, workforce structure and the impact of globalisation. 

5.1  Changes from industrial to service sectors  
In the last three decades, sectoral employment has changed in line with the continuous global trend 
from agriculture and industry to service sectors. This ‘megatrend’ started more than 250 years ago, 
relocating workforce from agriculture to industry, and continued in the 20th century, employing far fewer 
workers in industry and more in service occupations. These megatrends drastically changed the working 
and living conditions — connected with a strong reduction of the population in the countryside and the 
growth of cities. 

At first glance there is clear evidence about the impact of this change on OSH: it means less heavy and 
dangerous work in agriculture and industry, more office-like work, and more human–human interaction 
(specifically in education, social work, health and care) instead of human–material or human–machine 
interaction.  It  has  to  be  noted  that  even  human–human  interaction  is  more  and  more  partly  or  fully 
supported by digital communication tools, replacing paper and face-to-face communication. 

The three-sector categorisation (agriculture, industry, service) is mostly used to describe economic 
and  societal  changes  at  a  very  aggregated  level.  It  has  its  limitations  and  can  even  lead  to  false 
presumptions if it is used to describe working conditions. Particularly ‘service’ sector is a too broad a 
term  to  draw  conclusions  on  working  conditions,  that  is,  the  simplified  assumption  that  work  in  the 
service sector is nearly always office work. Work in the ‘Service sector’ includes transport and delivery, 
care and health work, education and social work, domestic work, cleaning work, maintenance and repair, 
retail, and of course a very large share of administrative office work, practically in all economic activities.  

This three-sector system does not facilitate a realistic quantitative picture about working conditions. For 
example, statistically an accountant in a steel plant is counted as an employee in industry, whilst an 
employee of a subcontractor who does heavy manual repair work in the same steel plant is counted as 
a service worker.  

In the same way, the construction sector does not fit well into this triple categorisation; statistical offices 
often separate it from industry in their classification systems.  

However,  having  these  limitations  and  possible  distortions  in  mind,  the  sectoral  categorisation 
system helps to broadly describe changes of the economic structure that obviously influence working 
conditions.  

Even during the past three decades the trend from agriculture and industry to other service-dominated 
sectors  continued  in  the  EU,  as  the  following  Eurostat  figure  shows.  The  share  of  employees  in 
agriculture  went  down  from  8%  to  4%,  and  also  down  in  industry  from  21%  to  15%,  construction 
remained quite stable between 6% and 7% whilst all the service sectors (except ‘Financial services and 
insurance’) gained a bigger share, particularly ‘Professional, scientific and technical activities’.  

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Figure  37:  Share  of  10  main  economic  activities  in  EU  total  employment  1996  and  2019  (%),  EU28  – 
Eurostat266 

These changes in the size of the workforce in aggregated sectors contributed to the development of 
health  and  safety  that  we  observed  in  the  past  30  years,  and  the  decrease  in  accidents  and 
traditionally recognised occupational diseases.  

These sectoral changes also triggered a crucial extension of the focus of OSH, adding to accidents 
and  specific  occupational  diseases  the  work-related  diseases,  broadly  extending  the  scope  of 
occupational diseases. The relation between work-related risks and major disease groups came  into 
focus. Most of these  diseases groups are not covered by the spectrum of conventional occupational 
diseases,  for  example,  most  musculoskeletal  and  digestive  diseases,  cardiovascular  and  mental 
diseases. Work is a crucial element for health in life, and to neglect its impact would generate a less 
than complete picture of health risks.  

These  trends  led  to  structural  changes  and  adaptations  in  practices  of  OSH,  topics  like  work 
organisation and psychosocial risks gained a much higher importance in the assessment of working 
conditions.267  

In a wider context, the shift to service work also changed the work performance measuring methods. 
Performance  measuring  cannot  be  based  anymore  on  simple  output  rates  (measured  in  pieces  of  a 
product,  or  in  physical  quantities  like  cubic  or  square  metres).  The  output  measurement  methods 
shifted  to  the  achievement  of  objectives,  milestones,  deadlines,  measurable  service  outputs, 
client satisfaction and other typical service-related performance indicators.  

The change towards service sectors also  goes along  with a fast, large-scale shift in the  provision  of 
education and care from families to professionals. This means a growth of workforce in sectors with 
human–human  interaction  and  the associated emotional challenges.268 This  is not the case  only in 
education and care; in general there is a higher psychosocial burden in those occupations where work 
with human beings as ‘clients’ takes place, increasing the risks of emotional exhaustion and of difficult, 
inattentive or even aggressive clients.  

Here it has to be mentioned that also work in service sectors has its specific ‘classic’ safety and 
accident risks, particularly in traffic and transport, maintenance and repair but also in sectors like health 
and care (lifting, infections, needles, etc.). And this is true also the other way around — work in agri-
culture,  construction  or  industry  is  definitely  not  free  from  psychosocial  risk  factors  and  its 
impact on mental health, also this work relies on human–human interaction.  

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This trend generates new and complex challenges for OSH policies and legislation, and also for 
practical OSH management in enterprises. On the one hand, the level of safety and health prevention 
for the conventional types of work has to be kept high. On the other hand, the health risks caused by 
inadequate work organisation, psychosocial burden of different kinds and physical inactivity still need 
more awareness and require the implementation of partly new preventive approaches.  

5.2  Technological developments – influence on OSH  
During the past 20 years significant technological developments and changes have taken place in 
all sectors at nearly all workplaces. Literature related to the relation between technology development 
and OSH focuses on horizontal or cross-cutting technologies that influence all sectors, particularly 
automation and digitalisation as its main elements and drivers. Digitalisation facilitated the development 
of new services based solely on digital technologies. It has an enormous impact on practically all types 
of work. Digital technologies now provide essential services to all sectors of our economy and society. 269 
The  European  Centre  for  the  Development  of  Vocational  Training  (Cedefop)  estimates  that  7  of  10 
workers  need  ‘at  least  some  fundamental  ICT  level  to  be  able  to  perform  their  jobs.’ 270  These 
developments considerably influence the ways of interaction between humans and between humans 
and machines.  

Beside  such  major  cross-cutting  technologies  there  are  numerous  essential  sector-  and  process-
specific  technological  developments  that  influence  work  in  a  sector  or  occupations.  Technological 
developments are often based on the application of several intertwined technologies, for example, 
mechanical engineering, microelectronics, chemical engineering and optical technologies. The progress 
of effectiveness, speed  and price of transport technologies might  illustrate this. This progress was 
essential  for  the  growth  of  international  trade  and  the  organisation  and  functioning  of  supply  chains 
between countries and continents. This development  needed the computerisation of the  logistics but 
also progress in manufacturing of trains, trucks, ships and aircraft towards lower costs, higher speed, 
higher capacities and high reliability.  

New material technologies (nanotechnologies, chemicals, plastics) have replaced classical materials 
(wood,  stone,  metals)  and  consequently  influenced  health  and  safety  risks  in  many  sectors. 
Biotechnologies  have  had  much  influence  in  sectors  like  agriculture,  food  processing  and 
pharmaceutical production. Technologies for renewable energy generation facilitate the change from 
centralised large-size and plant-based energy generation to decentralised systems, that is, the shift from 
fossil fuels to renewable sources and to new storage systems, like the development of more effective 
batteries. Also the change towards a circular economy and more recycling requires technologies for 
the effective and safe reuse of materials and equipment.  

At the same time — contrary or in parallel to a mainstream of technological developments — there is a 
small  but  emerging  societal  trend  of  de-technologisation  and  de-globalisation,  that  is,  niche 
trends  like  ‘Bio’, ‘Eco’ and ‘Regional’, predominantly  in  agriculture and  in  food and cloth  production. 
This trend is often caused by ethical and/or environmental considerations on certain types of products, 
for example, related to the consumption of meat or fish and the use of plastics-based products and fast-
fashion clothes. This trend generates — on the producers’ side — working conditions with partly distinct 
OSH requirements, that is, more safety risks in manual and craft work, and health risks typical for the 
handling of less treated materials and products, that is, more biological risks. A similar development 
can be observed in human-centred sectors: individual personal contacts are part of a service offer, 
mostly higher valued than standardised approaches or even a machine- or computer-supported advice 
or treatment.  

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Digitalisation and its impact on economy and work is a major topic in political and scientific discussions. 
Obviously the term ‘Digitalisation’271 covers such a broad array of technologies and developments that 
statements on their impact on society, economy and work can rarely be simple and straightforward. 272 
Digitalisation  includes  technical  issues  like  5G  coverage,  widespread  connectivity,  IoT  and  big  data, 
wearables, semiconductor capacities, edge and cloud computing, AI, data handling issues, for example, 
of medical records, mobile devices and online platforms, and it triggers economic and societal changes, 
for example, of business models, skills development, education and digital government.  

Digital transformation is globally supported by governments using financial, political and legal measures. 
The European Commission launched in February 2020 the European Digital Strategy 2020-2025. This 
strategy aims to promote a new generation of digital technologies. 

Concerning the overall impact of digitalisation on work, most researchers state a decrease of certain 
types of work and growth of others. Cedefop describes this as ‘the great divide’ and writes:  

‘Cedefop’s European skills and jobs (ESJ) survey reveals that more than 7 in 10 adult employees in the 
EU need at least some fundamental ICT level to be able to perform their jobs. Yet, about one in three 
of those employees are at risk of digital skill gaps. At the same time, almost half of all employees in low-
skilled occupations do not require ICT skills to do their work. Cedefop … notes that ‘the digital divide is 
alive and well. A strikingly high share of the EU adult workforce is still employed in a semi-analogue 
world, at the same time that others are faced with technological obsolescence.’ 273 

A statement of two researchers from the Massachusetts Institute of Technology shortly summarises this:  

‘Technologies such as payroll-processing and inventory-control software, factory automation, computer-
controlled  machining  centers,  and  scheduling  tools  have  replaced  workers  on  the  shop  floor  and  in 
clerical  tasks  and  rote  information  processing.  By  contrast,  big  data,  analytics,  and  high-speed 
communications have enhanced the output of people with engineering, creative, and design skills and 
made them more valuable. The net effect has been to decrease the demand for low-skilled information 
workers while increasing the demand for highly skilled ones.’ 274  

Digital  technologies  can  enhance  prevention  at  workplaces.  They  can  help  to  separate  workers 
from hazardous working situations, facilitate better  and innovative ways of monitoring exposure, and 
might  improve  the  quality  of  work  by  relieving  workers  from  repetitive  or  routine  tasks.  Digital 
technologies may also create higher levels of autonomy and flexibility or facilitate the access of a more 
diverse workforce to the labour market, in particular vulnerable groups such as disabled people, ageing 

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workers and those with care duties at home. Digitalisation also offers opportunities for more effective 
OSH training, advanced workplace risk assessment, communication and OSH inspections.  

Digital technologies can worsen the OSH situation at workplaces. Depending on how technologies 
are  designed  and  implemented,  on  the  organisational  context  and  on  the  employment  status, 
digitalisation  may  result  in  workers  being  more  exposed  to  OSH  risks  such  as  ergonomic  and 
psychosocial risks, with an increase in work-related stress, increasing performance pressure and work 
complexity, facilitating irregular working hours, reducing social interaction and support at work, blurred 
boundaries between work and private life, and new forms of dislocated work with unclear employment 
status.  Technical  concerns  relate  to  aspects  like  safe  interaction  of  workers  with  robots  and  semi-
autonomous  machines  and  vehicles.  The  extensive  use  of  data  has  the  potential  to  harm  privacy 
interests. Digitalisation can create abrupt (disruptive) and emerging changes at workplaces and 
with that very different challenges for OSH. 275 Eurofound summarised the opportunities and risks of ICT-
based mobile work in a table format.276  

Table 27: Opportunities and risks of ICT-based mobile work – Eurofound 

EU-OSHA observes particular risks for safety and health in:277 

low standards of OSH (particularly ergonomic) in mobile and home-based work,  
safety of robots, cobots and autonomous vehicles, 

• 
• 
•  platform work with low OSH standards,  
•  enhanced and detailed surveillance,  
•  permanent availability, and 
•  physical inactivity, permanent sitting and focusing on digital equipment.  

EU-OSHA included in its ESENER 2019 survey several questions regarding digitalisation and OSH in 
enterprises. There is a great diversity when it comes to the types of digital technologies reported by the 
establishments. PCs at fixed workplaces (86% of surveyed establishments in the EU27) and laptops, 
tablets, smartphones or other mobile devices (77%) are frequently reported across all activity sectors 
and business size classes. Only 6% of surveyed establishments in the EU27 reported using none of the 
digital technologies.278  

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Table 28: Digitalisation and OSH discussed – ESENER 2019279 

Actually, only 24% of surveyed establishments in ESENER 2019 reported discussing about the potential 
impact of digitalisation on the health and safety of workers. Of those 24% of all surveyed establishments, 
77% discuss the need for continuous training to keep skills updated. The next major topics are prolonged 
sitting (65%) and the request for more flexibility for employees in terms of place of work and working 
time (63%).280  

Some  obvious  side  effects  on  working  conditions  require  political  actions.  In  response  to  the  rapid 
development of online platform work in the EU, the European Commission started several activities on 
how to protect people working through digital platforms. The new  Strategic  Framework on OSH 
aims at adapting the OSH directives on Workplace minimum requirements and Digital screen equipment.  

These fast and far-reaching changes by digitalisation have also triggered ethical concerns. The High-
Level Expert Group of the EU Commission on Ethics adds, referring to the development of AI: ‘In an AI 
context,  freedom  of  the  individual  for  instance  requires  mitigation  of  (in)  direct  illegitimate  coercion, 
threats  to  mental  autonomy  and  mental  health,  unjustified  surveillance,  deception  and  unfair 
manipulation.’ 281 In  a  report  from  2022,  EU-OSHA  highlighted  the  possible  consequences  of  AI  for 
worker management.282 

Major  environmental  changes  and  policies  influence  OSH.  The  enhanced  and  accelerated 
introduction  of  environmental  technologies  is  widely  supported  by  national  and  EU  policies. 
(Green  deal283 and  circular  economy.284)  Consequently,  the  number  of  workers  in  these  sectors  will 
increase  and  impact  the  working  conditions  of  many  workers.  Sectors/enterprises  dealing  with 
sustainable  technologies  grow  fast,  for  example,  decentralised  and  carbon-free  energy  production, 
green  products,  waste  and  recycling,  green  mobility  and  transport,  and  energy  saving  buildings’ 
renovation.  These  ‘green  jobs’  have  gained  a  relevant  and  sometimes  essential  share  in  several 
economic areas.285  

Sectors  like  construction  and  crafts  will  profit  significantly  from  this  development.  That  would  also 
mean that sector-typical OSH risks — accident risks — will ‘return’. Also new risks will emerge, a circular 
economy  approach 286 will  pose  additional  risks  in  recycling  and  waste  treatment,  due  to  more 
handling  of  contaminated  materials  and  probable  exposure  to  more  chemical  contaminants  and 
infectious biological agents.  

EU-OSHA summarises: ‘The new technologies or working processes associated with green jobs can 
lead  to  new  hazards,  which  call  for  new  combinations  of  skills  to  deal  with  them:  the  “old”  OSH 
knowledge cannot simply be transferred to them. Installing a solar water heater, for example, involves 
combining the skills of a roofer, a plumber and an electrician.’287 

In addition, many of the new green technologies often require new skills and new processes and might 
produce  unprecedented  OSH  risks  —  for  example,  fire  and  explosion  from  less  environmentally 
harmful  but  less  safe  chemicals.  However,  at  the  same  time,  green  technologies  support  risk 
reduction at source, due  to principles such as limitation of hazardous chemicals and materials and 

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less  environmentally  critical  processes  (see  for  example,  the  principles  of  ‘green  engineering’,  like 
prevention instead of treatment of waste288). 

Chemical  technologies  have  ousted  traditional  materials  and  processes.  The  United  Nations’ 
(UNEP) ‘Global Chemical Outlook’289 documents a strong growth of chemical production between 1970 
and  2010.  The  value  of  the  global  chemical  production  grew  from  US$171  billion  in  1970,  to 
approximately US$ 5.7 trillion in 2019, roughly 33 times more. 290 The EU had a share of $1.3 trillion or 
about 20% of the global value. In less than two decades between 2000 and 2017, the capacity doubled 
and grew from 1,186 million tons to 2,276 million tons.291,292 

The reasons for this strong growth are: a) the replacement of traditional materials (wood, stone, iron 
and  other  metals,  paper,  natural  fibres)  by  chemically  based  products  (foremost  plastics  and  multi-
material  products);  b)  the  replacement  of  traditional  technologies  by  chemical  processes  (e.g. 
gluing instead of screwing of connections in metal, two-component paints); c) the development of new 
products (e.g. electronic devices, new types of batteries, nano); and d) new applications (e.g. specific 
fertilisers and pesticides).  

Approximately 300 million tons of synthetic chemicals were consumed in the EU in 2019, 223 million 
tons, or 74%, were regarded as hazardous to health.  

Table 29: Production and consumption of chemicals by hazard class in the EU in 2019 – Eurostat293  

According to the detailed register data of the Swedish Chemicals Agency, 10 million tonnes of synthetic 
chemicals were used in Sweden in 2019 that were classified as hazardous to health and the environment 
(not counting petrol). That equals approximately 1 ton per citizen of such chemicals.294  

The  ESENER  2019  survey  provides  information  about  sectors  that  reported  a  particularly  high 
prevalence of dangerous substances. The percentage of enterprises reporting handling or exposure 
to  chemicals  are:  50%  in  ‘Manufacturing’,  49%  in  ‘Construction,  waste  management,  and  water  and 
electricity supply’, and 47% in ‘Human health and social work activities’. 295 

The  prevention  of  risks  from  the  use  of  chemicals  at  workplaces  is  done  according  to  extensive 
regulatory frameworks. The most relevant pieces of legislation at the EU level are the OSH Framework 
Directive, the Chemical Agents Directive, and the Carcinogens and Mutagens Directive. Legislation in 
other policy areas contributes to the reduction of risks from dangerous substances in workplaces, such 
as EU legislation on chemical substances and mixtures (CLP, the regulation on classification, labelling 
and  packaging  of  chemicals,  its  predecessor  directive  was  already  issued  in  1967;  REACH  the 
regulation on Registration, Evaluation, Authorisation and Restriction of Chemicals from 2007; and also 
specific EU and international legislation on specific aspects such as chemicals in waste, storage and 
transport,  in  specific  products  like  batteries  and  cars,  in  specific  sectors  like  agriculture,  in  natural 
environments like in water and soil, and in consumer products like food, detergents and cosmetics). 

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Biological agents have always been a risk at workplaces in several sectors, particularly in health and 
care, in agriculture and the food industry, in laboratories, and in wastewater treatment, waste disposal 
and  recycling.  Also,  climate  change  will  raise  the  risks  from  biological  agents  in  Europe,  due  to  the 
expected  warming  that  allows  biological  agents  from  tropical  and  subtropical  regions  to  migrate  to 
Europe. 296  An  increasing  resistance  of  bacteria  towards  antibiotic  treatment  is  a  particular  risk  in 
hospitals and care institutions.  

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The COVID-19 pandemic made the public aware of the powerful impact of these risks, and also of the 
high  risks  of  infections  in  some  occupations.  During  the  pandemic,  the  above-mentioned  list  of 
workplaces  with  well-known  risks  from  biological  agents  was  significantly  extended;  practically  all 
workplaces with direct human–human communication were included, for example, workers in education, 
workers in public transport, sales and restaurant personnel and so on.  

During the pandemic preventive measures for workplaces were introduced that might change future 
prevention  practices  towards  biological  agents,  for  example,  the  obligation  to  wear  PPE  might  be 
applied for many more worker groups and for more circumstances, more rules for the organisation 
of personal contacts and communication at work have been developed and tested in practice, stronger 
ventilation  might  be  implemented,  and  the  measures  might  include  a  significantly  higher  use  of 
disinfecting  chemicals.  The  future  development  —  be  it  regional  or  national  outbreaks  or  worldwide 
pandemics — is unforeseeable. The connections between global societies due to international supply 
and transport chains and tourism will definitely increase the risk of future worldwide pandemics. 

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5.3  Workforce structure  
The workforce was often set identical with employed workers under a permanent contract, on average 
mostly male, mainly national, and most of the skills were achieved during apprenticeships or studying. 
During  the  past  three  decades  a  rapid  economic,  technological  and  demographic  development  took 
place: the variety of contracts has grown, and the share of women and of an international workforce 
increased;  moreover,  the  average  age  of  the  workforce  is  rapidly  increasing;  and  technological 
developments require repeated and often permanent acquisition of new skills. All these developments 
have shattered traditional ideas and conceptions of working life.297 This also has an impact on OSH.  

Figure 38: Workforce structure, demography – Eurostat 

In 2005, approximately 80 million women and 101 million men were employed in the EU. This was 
a rate of female workforce of 44.1%; in 2019, this rate went up to 46.1%, with 90 million women and 106 
million men making up a total of 196 million workers. The employment rate of women between 15 and 
64 years stood in 2019 at 67.9% and the employment rate of men at 78.9%.298  

During the past 15 years the number of women in the Eurostat category ‘Employed persons’ (Employed 
persons = employees and employers including self-employed) grew by 12.9%. The number of female 
employees grew by 16.3% and the number of male employees by 7.8%.  

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Table 30: Development of male and female workforce in the EU27 between 2005 and 2019299  

Although female employment has grown faster than the men’s rate, the employment rate for men is still 
11% higher. Due to the much higher rate of part-time work — women 30%, men 9% 300 — the gender 
gap concerning participation in the labour market is higher when transforming the working time into ‘full-
time equivalents’ (FTE). EIGE calculated a difference of 16%: ‘The EU average FTE employment rate 
is 41% for women, compared to 57% for men.’301,302 

The average age of the workforce has drastically changed during the last 17 years. In 2005, the age 
class between 55 and 64 years represented 11.1% of all employed persons, and in 2019 already 18.4% 
of the workforce — a growth of 16 million employed persons. At the same time, the share of the age 
class  between  15  and  39  years  decreased  from  49.6%  to  41.6%,  or  8.5  million.  Already  5.1  million 
employed persons are older than 65 years, making up a share of 2.6% of the workforce.303 

Table 31: Average age of the EU27 workforce304 

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The development of skill levels shows the most significant changes in the period between 2005 and 
2020. When comparing 2005 with 2020, for most occupations higher skills are required. In this period, 
the share of occupations requiring the three lowest education levels fell from 24.5% to 15.5%; the share 
of occupations that require a tertiary education grew from 24.9% to 36.4%. 

Figure 39: Workforce structure, skill levels – Eurostat305 

The migrant and mobile workforce in the EU27 also increased in the past two decades. The majority 
of migrants are intra-EU, that is, all workers who are born in a Member State other than the one where 
they currently work and reside; this number is estimated at 10.4 million (2019), based on LFS data.306 
Cross-border workers account for another 1.5 million307 and posted workers for 2.4 million.308 In 2020, 
8.6 million extra-EU citizens (born outside the EU) were employed in the EU labour market, out of 196 
million  persons  aged  from  20  to  64,  corresponding  to  5.3%  of  the  total. 309 The  sum  of  all  different 
categories of mobile extra- and intra-EU workers is roughly about 23 million, or about 12% of the EU 
workforce.  

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Figure 40: Workforce structure, mobility and migration – European Commission 

Regarding  OSH,  it  is  important  to  consider  that  migrants  from  non-EU  countries  are  over-
represented in  certain  sectors  and occupations like cleaners and  helpers,  personal services and 
care, building workers, mining, manufacturing, transport, food and agriculture. The next table shows the 
percentage  of  non-EU  citizens  in  the  workforce  of  certain  occupations  compared  to  the  share  of 
workforce of EU citizens in the same occupations.310 

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Table 32: Non-EU Migrants – over-represented in certain sectors and occupations in 2019 

The highest share of intra-EU and extra-EU workers per occupation is among cleaners and helpers 
(37% in total, intra-EU 11%, extra-EU 25%), labourers in mining and construction (24% in total, intra-
EU 7%, extra-EU 17%), stationary plant and machine operators (20% in total, intra-EU 6%, extra-EU 
14%), and personal care workers (19% in total, intra-EU 5%, extra-EU 14%).311  

The occupations with a high share of migrant workforce are those with higher physical risks and 
lower expectations to do this job until 60 years old. The common characteristic of these occupations 
is the well-known 3-D assignment: dirty, dangerous and demanding.312 

Beside the occupation-related risks, specific health and safety issues might result from a lower level of 
language dominance; communication and instruction have to cope with different capacities to speak and 
understand.  In  a  more  diverse  workforce  other  factors  might  differ,  like  awareness  and  traditions 
regarding aspects such as the importance of hierarchy, ways to communicate, perception of behaviour 
as aggression, harassment and discrimination. In general, a greater variety of the workforce poses wider 
challenges for prevention. 

Posting  of  workers  has  similar  implications  for  the  organisation  of  OSH  in  enterprises. 313 Posting 
means  that  companies  provide  services  in  other  EU  Member  States  without  having  to  establish 
themselves in the other countries. They send out employees to carry out the tasks required. The latest 
official data from 2020 estimated 2.3 million posted workers in the EU.314  

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Figure 41: Posted workers, receiving and sending countries in the EU315 

Unambiguously, the data show that all eastern and southern European countries are senders (exception 
Malta).  The  central  European  countries  Germany,  France,  Belgium  and  Austria  and  the  two  Nordic 
countries  Sweden  and  Finland  are  the  receivers.  Some  smaller  countries  like  Denmark,  Ireland  and 
Luxembourg are exceptions, and the Netherlands has an equal amount of sent and received posted 
workers. 

5.4  Globalisation and OSH 
Globalisation is an economic development accelerating during the past three decades. Over the 
last  decades,  production  and  services  have  become  less  and  less  solely  based  on  national  pre-
production  or  national  service  suppliers  but  instead  on  international  supply  chains. 316 International 
supply chains require logistics connections between countries and continents, harmonised technical 
standards, and, as far as possible, common legal rules and agreements, be it for services or materials 
and products. The development of such supply chains divides the necessary work related to a product 
or a service in parts, which might also mean that the OSH risks might not be shared in a fair or equal 
way. A fair divide is most probable between economies of similar levels of development, but a main part 
of globalisation is trade between different levels of economic and technological development.  

A relevant part of outsourcing to less-developed countries took place in sectors with high OSH risks: 
mining, metallurgic processes, hazardous waste, basic chemicals  and textiles. At the same time, EU 
enterprises  ‘import’  health  and  safety  risks  by  producing  goods  for  export,  for  example,  vehicles, 
machines, food or specialty chemicals. A full assessment of the divide of OSH risks needs a case-
by-case description; a variety of  different shares of  risk is possible: there  might take place reverse 
developments,  for  example,  open-pit  mining  in  a  country  will  probably  bear  much  lower  risks  than 
underground coal mining in the EU, and the risks inside the EU might increase due to (partly illegal) 
import  of  non-standard  or  even  prohibited  products  and  equipment  into  the  EU  (e.g.  non  certified 
machines or equipment, cooling agents), and the other way around: EU enterprises might produce and 
export  products  whose  use  is  prohibited  in  the  EU  (e.g.  pesticides).  Regarding  the  globalisation  of 

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services that do not require personal presence, digitalisation facilitates a massive global deployment of 
the workforce. 

From an OSH point of view, it would be beneficial to investigate the divide of OSH in the whole supply 
chain, that is, leaving the restricted focus on OSH in the limited European share of the production chain. 
It would also generate a clearer picture of how the status of OSH in the EU would look after considering 
the import and export of risks.317 The national or European OSH data simply cannot give the full picture 
in a globalised production setting.318  

Approaches promoting OSH at all workplaces in these chains or networks can mitigate the negative 
impacts of the relocation of production and service processes with high OSH risks. Global enterprises, 
business federations, NGOs and governments support supply chain promotion; often it is a part of fair-
trade  agreements  or  actions.  Approaches  promoting  OSH  at  all  workplaces  in  these  chains  or 
networks can mitigate the negative impacts of the relocation of production and service processes with 
high OSH risks. Examples are certificates of business organisations, the Global Reporting Initiative topic 
Standard for Occupational Safety and Health,319 and the UN Principles for Responsible Investment.320 
Also,  national  legislators  are  considering  or  discussing  or  have  already  agreed  on  supply  chain 
legislations.  In  2022,  the  European  Commission  proposed  a  supply  chain  law,  called  ‘Corporate 
sustainability  due  diligence’,  and  the  expectation  is  that  ‘The  new  rules  will  ensure  that  businesses 
address adverse impacts of their actions, including in their value chains inside and outside Europe.’321 

Already in 2017 the EU issued a directive on several ‘conflict minerals’ (tin, tantalum and tungsten, their 
ores, and gold). Its functioning is described in the preamble as follows: ‘… supply chain due diligence is 
an ongoing, proactive and reactive process through which economic operators monitor and administer 
their purchases and sales with a view to ensuring that they do not contribute to conflict or the adverse 
impacts thereof.’ 322  

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Globalisation does not only refer to products and services but also to workforce that is working in other 
countries  on  the  same  or  another  continent,  temporarily  or  seasonally,  sometimes  permanently.  An 
exchange of workforce of a similar level of skills and employment conditions probably poses few risks 
regarding OSH. A relevant risk shift takes place when workers from low- or medium-income countries 
take over hard, dangerous and dirty work in high-income countries.  

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ICOH stated in its Centennial Declaration: 

‘The globalization process has not succeeded in equalising the conditions of work but in fact the opposite 
has  occurred;  the  gaps  are  increasing.  Poverty,  inequality  and  under-development  are  closely 
associated with the poor safety, health and social conditions of work, as they are also linked with illiteracy, 
lack of education, poor access to health services and low or non-existent social protection.323 

International organisations like the ILO, WHO and UN have also taken up the task to promote OSH 
worldwide. The ILO has established a system of conventions; their implementation is monitored in the 
signature states.324 The ILO has issued and decided on nine ‘Fundamental conventions’ that have been 
signed by 92% of the ILO member states. 325 These fundamental conventions are: 

1. Freedom of Association and Protection of the Right to Organise Convention, 1948 (No. 87); 

2. Right to Organise and Collective Bargaining Convention, 1949 (No. 98); 

3. Forced Labour Convention, 1930 (No. 29) (and its 2014 Protocol);  

4. Abolition of Forced Labour Convention, 1957 (No. 105); 

5. Minimum Age Convention, 1973 (No. 138);  

6. Worst Forms of Child Labour Convention, 1999 (No. 182); 
7. Equal Remuneration Convention, 1951 (No. 100); 
8. Discrimination (Employment and Occupation) Convention, 1958 (No. 111); and 

9. (since 2022) Two conventions on Occupational Safety and Health, that is, C-155 Occupational 
Safety and Health Convention, 326 and C-187 Promotional Framework for OSH Convention.327  

The ILO also promotes the ‘Decent work’ approach to improve working conditions, covering aspects 
like  fair  income,  social  protection  for  families,  better  prospects  for  personal  development  and  social 
integration, and equal opportunities and treatment. In the frame of this approach, the ILO has developed 
flagship  programmes  like  ‘Safety  and  Health  for  all’ 328 and  the  ‘Global  Action  for  Prevention  on 
Occupational Safety and Health’ (OSH-GAP), a programme to support and promote OSH globally. 329 
Its priorities are:  

• 

legal, regulatory and adjudicative frameworks that address and integrate OSH, including core 
OSH laws and technical regulations; 

•  enforcement and compliance with OSH in workplaces, including public, private and non-

governmental systems that operate independently or in concert; 

•  employer and worker competencies that are necessary to achieve and sustain OSH at global, 

national and enterprise levels; 
social dialogue that supports OSH; 

• 
•  public and private financial resources for investment in OSH; 
•  occupational health services including public and private health services; 
•  employment injury insurance programmes that support prevention of OSH fatalities, injuries 

and illnesses; 

•  OSH professionals, institutions and networks; 
•  OSH indicators and implementation of effective methodologies for OSH data collection; and 
•  demand for the safety and health of workers and workplaces.  

The International Social Security Association (ISSA) developed the Vision Zero initiative. 330 ISSA 
promotes  together  with  enterprises  and  many  global  OSH  organisations  this  concept,  aiming  at  the 
complete elimination of work accidents and occupational diseases.  

The UN has developed a set of targets and indicators, the Social Development Goals (SDG).331 Target 
8 is dedicated to ‘Promote sustained, inclusive and sustainable economic growth, full and productive 
employment and decent work for all’. Sub targets are: 

8.5 By 2030, achieve full and productive employment and decent work for all women and men, 
including for young people and persons with disabilities, and equal pay for work of equal value 

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8.7 Take immediate and effective measures to eradicate forced labour, end modern slavery and 
human trafficking and secure the prohibition and elimination of the worst forms of child labour, 
including recruitment and use of child soldiers, and by 2025 end child labour in all its forms 

8.8 Protect labour rights and promote safe and secure working environments for all workers, 
including migrant workers, in particular women migrants, and those in precarious employment 

The WHO is following a global approach towards occupational health. They summarised their base of 
evidence on global working conditions in some key facts:332 

• 

In many countries more than half of workers are employed in the informal sector with no social 
protection for seeking health care and lack of regulatory enforcement of occupational health and 
safety standards. 

•  Occupational  health  services  to  advise  employers  on  improving  working  conditions  and 
monitoring the health of workers cover mostly big companies in the formal sector and more than 
85% of workers in small enterprises, informal sector, agriculture and migrants worldwide do not 
have any occupational health coverage. 

•  Work-related health problems result in an economic loss of 4–6% of GDP for most countries. 
The basic health services to prevent occupational and work-related diseases cost on average 
between US$ 18 and US$ 60 (purchasing power parity) per worker. 

•  About 70% of workers do not have any insurance to compensate them in case of occupational 

diseases and injuries. 

•  Research  has  demonstrated  that  workplace  health  initiatives  can  help  reduce  sick  leave 

absenteeism by 27% and health-care costs for companies by 26%. 

Based on this evidence, the WHO Global Assembly agreed on a ‘Worker health global plan of action’ in 
2007 333 (updated 2013) that included targets like better prevention at workplaces, that is, Objective 2: 
to protect and promote health at the workplace. The WHO has worked together with the ILO to estimate 
the  burden  of  diseases  from  work  and  published  the  ‘WHO/ILO  joint  estimates  of  the  work-related 
burden of disease and injury’.  

When looking at the work of global institutions during the past two to three decades — and for the ILO 
also  much  further  back  —  many  important  agreements,  conventions,  government  actions  and 
global business programmes have been negotiated, agreed and issued. The objectives and necessary 
measures at a global level have been made much more concrete by these efforts. OSH and working 
conditions are on the agenda of these organisations, and general and concrete targets and indicators 
have been set. The task is the implementation of these principles and programmes in every region 
and country of the world in a way that it reaches all workplaces.  

OSH Barometer – OSH Infrastructure – International organisations and international programmes  
https://visualisation.osha.europa.eu/osh-barometer/osh-infrastructure/international-organisations 
https://visualisation.osha.europa.eu/osh-barometer/osh-infrastructure/international-programmes 

ESENER – Data visualisation  
https://visualisation.osha.europa.eu/esener/en/survey/datavisualisation/2019 

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6  OSH legislation and OSH infrastructure in the EU 
6.1  Foundation, legislation, compliance and supervision  
The ethical and economic importance of safe and healthy working conditions led to an integration 
of this target in international conventions and agreements; it is also embedded in the treaties of the EU. 

 UN has included ‘Safe and secure work environment’ as an indicator for Goal 8 of their 17 global 
‘Sustainable  Development  Goals’  for  2030.  Goal  8  aims  to  ‘Promote  sustained,  inclusive  and 
sustainable economic growth, full and productive employment and decent work for all’. 334 It requests in 
its target 8.8 to ‘Protect labour rights and promote safe and secure working environments for all workers, 
including migrant workers, in particular women migrants, and those in precarious employment.’ 

The  Preamble  to  the  Constitution335 of  the  ILO  includes  as  an  objective  ‘…  the  protection  of  the 
worker against sickness, disease and injury arising out of his employment ...’. In 2022, the objective of 
a safe and healthy working environment became part of the ‘Declaration on Fundamental Principles and 
Rights at Work’, adding OSH to the existing four basic principles, that is, 1) freedom of association and 
right  to  collective  bargaining,  2)  the  elimination  of  all  forms  of  forced  or  compulsory  labour,  3)  the 
effective  abolition  of  child  labour,  and  4)  the  elimination  of  discrimination.  Between  the  year  of  the 
foundation  in  1919  and  today,  the  ILO  agreed  on  more  than  40  conventions  and  recommendations 
addressing OSH, be it either general provisions or provisions for specific groups and sectors or specific 
risks.336  

The EU and its predecessors have enshrined health and safety of workers in their founding treaties. 
Already in 1951, it was stated in Article 3 of the European Coal and Steel Community (ECSC) Treaty 
that ‘The institutions of the Community shall, within the limits of their respective powers, in the common 
interest … promote improved working conditions and an improved standard of living for the workers in 
each  of  the  industries  for  which  it  is  responsible  …’. 337 During  the  development  of  the  European 
institutions and the EU from those years until today, references to working conditions and safety and 
health were always part of the treaties, and also in the latest Treaty of Lisbon from 2009.338 

In Article 151 of the Lisbon Treaty, it is stated that ‘The Union and the Member States, shall have as 
their objectives the promotion of employment, improved living and working conditions …’. The areas of 
such promotion are set  out in Article  153, where two bullet  points refer to OSH: (a) improvement in 
particular of the working environment to protect workers’ health and safety; (b) working conditions. In 
2017,  the  European  Commission  launched  an  initiative  to  agree  on  the  ‘European  Pilar  of  Social 
Rights’ (EPSR), comprising 20 key principles guiding the EU in the field of social policy.339 These pillars 
were agreed by the Member States; Principle 10 refers to a ‘Healthy, safe and well-adapted work 
environment and data protection.’ 

These European and international agreements and treaties regard safety and health as essential for 
human development, a basic human right. The main reasoning is to eliminate or reduce as much as 
possible suffering, sickness, disability and death of workers. Often the reasoning refers to intertwined 
objectives, that is, to economic growth (UN), or to reduce the economic burden of incomplete health and 
safety  at  work,  be  it  the  burden  for  enterprises  or  the  society  as  a  whole,  that  is,  by  ‘Promotion  of 
employment’  (Lisbon  Treaty)  or  by  ‘Prolongation  of  the  participation  in  the  labour  market’  (EPSR)  or 
‘Data protection’ (EPSR).  

The  EU  treaties  form  the  legal  background  for  the  development  of  specific  EU  legislation,  related  to 
working  conditions  in  general  and  OSH  in  particular.  In  1989,  the  EU  agreed  on  the  Framework 
Directive, a major step regarding OSH. 340 This directive introduced a distinguished preventive approach, 
based on a comprehensive risk assessment, as a dominant legal standard across all Member States. 
Its legal obligations prescribe several basic principles: 

• 

• 
• 

the responsibility of employers for OSH, that is, ‘the employer shall take the measures 
necessary for the safety and health protection of workers, including prevention of occupational 
risks and provision of information and training’,341 and the obligation of workers ‘to take care 
as far as possible of his own safety and health and that of other persons affected …’;342 
the obligation to evaluate all risks (risk assessment); 
the preference of the risk elimination at source (combating the risk at source), a hierarchy of 
prevention measures, replacing the dangerous by the non- or the less dangerous; 

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•  adapting the work to the individual but also preference of collective solutions;  
•  adaptation to technical progress;  
•  giving adequate instructions; 
•  consultation obligations, that is, worker participation; and  
• 

training requirements for OSH practitioners and professionals in enterprises.  

It directed the scope of the legislation from prescribed worker protection rules to active preventive 
formation of the work environment.343 The Framework Directive does not refer to specific workplace 
risks,  instead  it  lays  down  general  principles  to  prevent,  reduce  or  eliminate  risks.  Many  pieces  of 
previous EU legislation like the Directive on the protection of workers from risks related to exposure to 
chemical,  physical  and  biological  agents  at  work  from  1980344 and  the  Directive  on  the  protection  of 
workers  from  noise  from  1986345 were  updated  after  1989  to  fully  comply  with  the  provisions  of  the 
Framework Directive.  

Based on the principles of the Framework Directive, 24 individual OSH directives 346 lay down specific 
measures to cope with risks and exposures for: workplaces and equipment (work places, workplace 
equipment,  explosive  atmospheres,  warning  and  safety  signs,  PPE,  display  screens),  exposure  to 
chemical agents (chemical agents at work, carcinogens and mutagens, occupational exposure limits), 
to  physical  hazards  (ionising  radiation,  electromagnetic  fields,  artificial  optical  radiation,  noise, 
vibrations)  and  to  biological  agents  (biological  agents  at  work),  and  ergonomic  risks  (handling  of 
loads). Some of them deal with sector-specific risks (in construction, mineral extraction, fishing and 
healthcare) or specifically with worker groups (young workers, pregnant workers, temporary workers). 

The chronological overview of the directives suggests that a main phase of legislator activity lasted 
approximately 15 years, between 1989 and 2004.347  

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Table 33: EU Directives on Occupational Safety and Health 

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New directives or revisions and updates of directives were introduced for several reasons, that is, 
coverage of new technologies like artificial optical radiation (use of laser cutting, etc.), or new evidence, 
that is, after 2017 the Carcinogens and mutagens directive was extended several times, covering now 
many  more  substances.  The  revision  of  the  directives  on  Display  screen  equipment  (enormous 
technological  developments  since  its  introduction)  and  the  revision  of  the  Directive  on  Minimum 
requirements at workplaces (e.g. to better cover OSH at mobile work places outside the premises of 
the employer) is an objective of the EU Strategic Framework on Health and Safety at Work 2021-2027348.  

In the light of the changes in working conditions towards physical inactivity and repetitive work and 
the higher psychosocial and emotional demands, the European Commission and the Member States 
and stakeholders initiated several activities. Over the last 10 years, the European Commission made 
efforts to promote the approach that ‘psychosocial risks and stress’ are part of OSH and, as such, they 
are covered by the OSH Framework Directive. Some countries updated their legislation and explicitly 
included an obligation to include psychosocial risks in risk assessment, while others have developed 
extensive  guidance  for  enterprises  and/or  labour  inspections.  Similar  activities  can  be  observed 
regarding MSDs. 

The Machinery directive 2006/42/EC is only one example of a — very general — regulation of these two 
aspects at EU level:  

‘Under  the  intended  conditions  of  use,  the  discomfort,  fatigue  and  physical  and  psychological 
stress faced by the operator must be reduced to the minimum possible, taking into account ergonomic 
principles such as: 

•  allowing for the variability of the operator’s physical dimensions, strength and stamina, 
•  providing enough space for movements of the parts of the operator’s body, 
•  avoiding a machine-determined work rate, 
•  avoiding monitoring that requires lengthy concentration, 
•  adapting the man/machinery interface to the foreseeable characteristics of the operators.’349 

EU directives and regulations in other policy areas influence OSH or contribute to better OSH, such 
as  the  Directive  2003/88/EC  concerning  certain  aspects  of  the  organisation  of  working  time,  and 
Directive 2019/1152 on transparent and predictable working conditions in the EU, the Machinery 
directive 2006/42/EC with some specific health and safety requirements, and also the CE marking of 
products as conforming with safety, health and environmental standards. 

The  quantitative  and  qualitative  degree  of  compliance  and  of  implementation  of  the  EU  OSH 
directives at workplace level is a constant topic in evaluation studies and expert meetings.  

A  comprehensive  evaluation  of  all  EU  OSH  directives  and  their  practical  implementation  was 
commissioned by DG EMPL in 2012 and published in 2015, analysing the relevance of the directives, 
their effectiveness, and the level of the implementation or compliance, based on literature, studies in 
each Member State, expert interviews and surveys. 350,351 

The authors conclude on the relevance of the EU OSH directives:  

‘The  evaluation shows very clearly that the  EU OSH  acquis  is the reference frame for national OSH 
regulatory regimes. While the Member States have chosen various models for their legal implementation 
of the Directives’ requirements, there is no doubt that the Directives’ requirements form the core of the 
national systems in one way or the other. The significance of the Directives in setting the scene for OSH 
regulation in the EU is therefore very high.’ 

The authors also distinguish between the two major principles of legislative approaches in OSH, that is, 
either setting an objective and letting the actors define how this goal can be achieved (goal-oriented 
approach),  or  prescribing  also  quite  detailed  measures  to  reach  the  objective  (prescriptive 
approach):352 

‘There seems to be a general view that the Framework Directive, with its orientation towards a goal-
oriented  approach  to  OSH  (rather  than  prescriptive)  successfully  lays  out  a  suitable  template  for 
managing workplace risks – but not in itself enough to ensure that all risks are dealt with sufficiently. 
One criticism of the goal-setting approach is that the absence of prescriptive intermediate goals makes 

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compliance  harder  to  verify  and,  in  the  absence  of  that  verification  procedure,  harder  to  enforce 
(especially in OSH cultures with a history of the prescriptive approach).’353 

Regarding the level of compliance with the legal goals or prescriptions, the study authors assess it 
as  ‘moderate  to  good.’  They  see  major  differences  depending  on  the  topic  and  the  size  of  the 
enterprises: 

‘However, the collected data shows that overall compliance with the OSH acquis across the EU and 
across establishment sizes is moderate to good. There is no indication that compliance is measurably 
higher in the public sector compared to the private sector. Yet, in reality, compliance varies significantly 
from directive to directive, from MS to MS and across establishment sizes. 

Micro  establishments:  Cannot  be  assessed  (limited  evidence  points  to  poor  overall  quantitative 
compliance) 

•  10 to 19 employees: Poor overall quantitative compliance 
•  20 to 49 employees: Moderate overall quantitative compliance 
•  50 to 249 employees: Good overall quantitative compliance 
•  250 to 499 employees: Good overall quantitative compliance 
•  500+ employees: Very good overall quantitative compliance’. 354 

In  2018,  DG  EMPL  organised  a  peer  review  on  ‘The  efficient  transposition,  implementation  and 
enforcement of EU OSH legislation’ for each EU Member State.355 The overall conclusion is positive but 
refers to the difference between formal (paper) compliance and ‘real improvements’:  

‘Although not uniform across employers (with evidence that smaller businesses in particular find some 
of the demands challenging and difficult to implement) indications are also that the transposed legislation 
is being implemented within workplaces. However, there are indications that the fact of implementation 
is not necessarily a true indicator of the quality of that action, with suggestions that “compliance” is to 
some extent a paper exercise and is not always reflected in real improvements in working environments.’ 

The  authors  of  EU-OSHA’s  ‘Supporting  compliance’  report356 note  the  same  difference,  using  the 
terms  ‘substantive’  versus  ‘rule  compliance’.357 This  report  and  underlying  literature  review  have 
specifically  analysed  reasons  and  context  for  compliance  and  non-compliance.  They  analysed  the 
influence of: 

social norms and social reporting strategies, and corporate social responsibility; 

• 
•  economic incentives and the business case for OSH; 
• 
the role of supply chain relations in supporting OSH; 
•  prevention services; and 
• 

strategies and practices adopted by OSH regulators.  

They conclude on a variety of aspects: ‘During the last half-century, there has been a significant and 
well documented move away from prescriptive regulatory standards and efforts by national regulatory 
agencies  to  enforce  them  towards  more  principle-,  performance-  and  process-based  regulatory 
requirements  ….  This  shift  was  originally  informed  by  notions  that  traditional  command  and  control 
strategies, however compromised by resource or governance, had achieved as much as they were likely 
to, and that different approaches were necessary to bring about the further improvements in OSH that 
were  desired. 358 (regarding  reasons  of  non-compliance  at  enterprise  level  see  also  the  chapter  on 
‘Prevention Practices in Enterprises’). 

Not all worker groups, sectors or forms of work are equally covered by these directives. Since the first 
protective  OSH  legislations,  some  important  groups  or  sectors  had  exceptions  from  full 
application of OSH legislation. Depending on the Member State, such exceptions are applied to self-
employed and contracted work, military, public sector, mining, workers in the marine sector and offshore 
installations,  family  members,  personal  and  household  services,  work  in  charitable  organisations, 
volunteers in general, and domestic and mobile workplaces. In addition to these existing exemptions, 
we can observe in the last two to three decades an accelerating trend of erosion of the conventional 
employer–employee relation. Examples are outsourcing of work to contractors, often to self-employed, 
or platform work.  

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Obviously, most informal, and — in particular — irregular and illegal types of work do not respect 
legal  OSH  obligations  —  and  at  the  same  time  legal  monitoring  obligations  also  fail.  The  EU 
Fundamental  Rights  Agency  (FRA)  published  several  case  studies  and  examples  in  a  series  called 
‘Severe  labour  exploitation  reports; 359 these  studies  provide  an  insight  into  most  irregular  working 
conditions.  

Undeclared work is defined as paid and lawful (not criminal) activity but undeclared to public authorities. (‘paid 
activities  that  are  lawful  as  regards  their  nature  but  not  declared  to  public  authorities,  taking  into  account  the 
differences in the regulatory systems of Member States’.)  

In 2018, the European Commission estimated the scale of undeclared work in the EU. According to this estimate, 
on average, 11.6% of total labour input in the private sector is undeclared, and undeclared work constitutes on 
average 16.4% of gross value added. The main sectors according to the Special Flash Eurobarometer from 2019360 
are  personal  services  (childcare/elderly  care/cleaning)  followed  by  construction  and  hospitality  services.361 The 
‘European Platform tackling undeclared work’ provides fact sheets about the type and quantity of undeclared work 
in all EU Member States.362  

The compliance of enterprises with OSH regulations is supervised by state institutions, mainly the 
Labour Inspectorates.363 At  EU  level, the SLIC  developed common principles for their work. These 
common principles aim at harmonising their work and facilitate collaboration; they include planning and 
monitoring,  inspectors’  competencies  and  independence,  prevention,  protection,  and  assistance  and 
guidance for inspectors, and internal and external communication.364  

Practically  all  labour  inspections  in  the  EU  Member  States  worked  in  the  past  two  decades  on 
organisational and strategic measures to achieve an effective and broad impact, and also to better 
adapt to new and emerging risks.365 To enhance the level of implementation in terms of coverage and 
quality, many labour inspections developed smart enforcement and supervision concepts.366  

 On average, two million visits per year were made by labour inspectorates, in approximately 22 million 
businesses  in  the  EU,  in  the  decade  2010-2020,  with  a  steady  decline  over  the  years.367 .368 Many 
enterprises  that  are  regarded  as  low-risk  establishments  have  never  been  inspected  by  a  labour 
inspectorate. Often more than one inspection is done in large enterprises, for example, as a follow-up 
inspection;  there  might  also  be  more  than  one  annual  inspection  in  enterprises  with  high  risks.  The 
labour inspection is also tasked to supervise enterprises with many separated sites or establishments, 
for example, construction companies and shops of supermarket chains. The visit of one headquarter or 
one shop cannot  be regarded  as a visit  of a representative selection of  enterprises’ locations, which 
possibly show different levels of safety and health.  

In the decade between 2000 and 2010, the development of the resources of labour inspections show a 
mixed  picture,  some  countries  extended  the  capacities  of  labour  inspections,  others  cut 
resources. 369 For  the  period  between  2010  and  2020,  the  European  Trade  Union  Institute  (ETUI) 
counted a decrease of labour inspectors and inspections in 20 of 27 Member States, a drop of 7% for 
inspectors  and  of  18%  for  inspections. 370 Again,  the  picture  between  Member  States  differs  but,  in 
general,  budget  or  staff  cuts  dominate.  ESENER  findings  show  that  there  was  a  significant  decline 
between 2014 and 2019 regarding the number of visits by Labour Inspectorates.371 

Although labour inspections are at the core of supervision of working conditions, other state authorities 
have  similar  or  related  tasks,  for  example,  regarding  the  control  of  undeclared  work,  checking 
minimum wages and social insurance contributions, and performing control of environmental or hygiene 
standards, of fire safety, or technical control of particularly dangerous production sites or equipment.  

The  shift  in  working  conditions  towards  psychosocial  risks  generates  new  challenges  for  state 
supervision.  SLIC  recommends  in  its  labour  inspectors’  guide  for  assessing  the  quality  of  risk 
assessments and risk management measures with regard to prevention of psychosocial risks:372 

‘When striving to prevent psychosocial risks, labour inspectors should take into account the fact that 
there  is  no  single,  across-the-board  solution,  and  should  recommend  expert  advice,  for  example, 
external OSH services, if needed for unusual or serious problems. A holistic approach is necessary in 
order to address psychosocial risks.’ 

Psychosocial risks at work were a topic in campaigns (EU-OSHA,373 European Commission,374 ILO,375 
WHO, 376)  in  many  national  OSH  strategies  (see  OSH  Barometer 377),  or  in  guiding  regulations,  for 

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example,  in  Sweden. 378  Meanwhile,  the  spectrum  of  guidance  developed  regarding  work-related 
psychosocial risks is very wide; it covers aspects such as job satisfaction (overall level of wellbeing), 
engagement, performance and work-related stress,379 and also discrimination, harassment, aggression 
and violence.380 

6.2  EU and national OSH strategies  
The EU and many Member States applied and apply strategic approaches, based on EU or national 
evidence  of  the  state  of  OSH.  OSH  strategies  are  a  steering  instrument  to  focus  the  activities  of  all 
actors on major recognised deficits of OSH infrastructures or processes.381  

The newest EU Strategic Framework on Health and Safety at Work 2021-2027 puts the focus on 
change, with the title ‘Occupational safety and health in a changing world of work’.382 Consequently, the 
strategic framework focuses on three key objectives for these years:  

• anticipating and managing change in the new world of work brought about by the green, digital 
and demographic transitions; 

• improving prevention of workplace accidents and illnesses;  

• increasing preparedness for any potential future health crises. 

The proposed focus areas and actions are related to these three objectives. Under the first key objective 
there are actions like ‘Modernising and simplifying EU OSH rules in the context of the green and digital 
transitions’; a special focus is on psychosocial and ergonomic risks. The second objective promotes a 
vision  zero  approach  to  work-related  deaths,  particularly  referring  to  hazardous  substances  and 
cardiovascular diseases, the promotion of health at work and inclusive workplaces for all. 383 

The third objective responds to the impact of the pandemic situation in 2020 and 2021. It includes the 
development  of  emergency  procedures  for  future  similar  situations  (‘Health  crisis’).  The  Strategic 
Framework  repeats  and  corroborates  the  value  of  research  and  data-based  evidence  by  stating: 
‘Research and data collection, both at EU and national level, are a pre-condition for the prevention of 
work-related diseases and accidents. Scientific advice and the latest technological developments feed 
into OSH legislation and policy.’ 

Also,  many  Member  States  have  agreed  on  provision  of  better  data  as  an  objective  in  their  national 
strategies.384 The EU strategy often gives orientation for the development of national OSH strategies. 
Under the last strategy period, 24 of the 27 Member States had applied a strategy. Many national OSH 
strategies contained similar targets. EU-OSHA published an overview report on national strategies, and 
the  OSH  Barometer  contains  as  one  indicator  a  harmonised  overview  on  the  aspects  of  national 
strategies.385 

OSH  strategies  are  regarded  as  an  important  and  innovative  policy  area,  a  chance  for  better 
collaboration, and also a very relevant joint national OSH activity. Those strategies help in priority setting 
and  focused  action  on  weaknesses.  Strategies  were  often  agreed  in  social  dialogue  processes,  and 
many strategy actors also developed new and better monitoring instruments and indicators.386 Labour 
inspections play an important or essential role in most of these strategies. 387 

OSH Barometer – Steering of OSH, National strategies:  
https://visualisation.osha.europa.eu/osh-barometer/osh-steering/national-strategies 

OSHWiki: Section ‘OSH System at national level’, descriptions of the OSH Systems of 
the EU Member States: https://oshwiki.eu/wiki/Category:OSH_systems_at_national_level  

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6.3  Guidance and support  
Supervision is only one approach to implementing legislation. As mentioned, supervision by state 
authorities can only reach a small share of all enterprises, particularly not the many small ones and the 
self-employed.  In  addition  to  supervision  and  control,  a  broad  variety  of  prevention-supporting 
activities has been developed during the past decades.388  

The  authors  of  EU-OSHA’s  ‘Supporting  compliance’  reports  state  a  strong  increase  in  ‘compliance 
promotion strategies’. They write: ‘The regulatory changes have been matched in more recent times by 
an increasingly diverse set of compliance promotion strategies. Not only has public regulation sought to 
engage  and  encourage  duty  holders  in  the  pursuit  of  forms  of  regulated  self-regulation,  but  …  the 
discourse on regulation itself has sought a far broader understanding of its meaning and the role of the 
private and public regulatory actors and processes potentially involved in  both defining and securing 
compliance.’389 

One important type of means are guidance and support tools for enterprises and workers to extend 
the reach and impact of legislation. Labour inspectorates and other state institutions produce these tools 
either themselves or in collaboration with social partners or professional organisations.  

Proactive research and preventive guidelines, particularly in situations of new risks, have become a 
quite usual preventive activity (e.g. on nanotechnology, or on some developments in digitalisation). For 
very complex regulations, like REACH, national institutions installed helpdesks. European institutions 
also publish such guidance documents for EU-wide use, for example, the guidance on health and safety 
in agriculture, 390 the guidance regarding the implementation of the Machinery directive,391 the guidance 
documents  of  EU-OSHA  on  COVID-19 392 and  the  European  Commission  guidance  documents  on 
seasonal  workers  and  COVID-19. 393 Practically  all  EU  and  international  OSH  institutions  published 
guidance documents on how to identify and reduce psychosocial risk at workplaces.394  

A large amount of OSH guidance already exists in different formats,395 starting with classical written 
guidance  documents,  increasingly  complemented  by  audio-visual  and  interactive  tools.  EU-OSHA 
covers a large variety of workplaces with its digital risk assessment tool OiRA (Online interactive Risk 

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Assessment).396 Many good examples of support for micro and small enterprises (MSEs) are available 
as identified in the comprehensive EU-OSHA reports on OSH in MSEs.397 

Often,  guidance  documents  show  the  difference  between  good  practice  in  prevention  and  risky 
practices, for example, the SLIC guidance on measures against exposure to respirable crystalline silica 
at construction sites.398 There are many of these good or best practice examples in literature, but there 
is  rarely  a  quantitative  estimate  of  the  occurrence  of  good  (or  moderate)  versus  poor  practice 
before and after the publication and promotion of such guidance documents, which would be crucial to 
estimate the impact of guidance and tools.  

Often  the  support  of  a  proper  implementation  is  done  by  European  national,  sectoral  and  regional 
employers’  and  workers’  associations.  They  contribute  to  supervision  and  implementation  by 
consultation  or  participation  in  steering  committees  and  so  on.  Some  of  them  produce  specific  OSH 
information  or  guidance  for  their  members,  adapted  to  the  main  topics  of  the  organisation. 399 They 
participate in the development of national strategic approaches or OSH campaigns. In all EU Member 
States there exist fora for social dialogue at regional, sectoral or national level (overview in OSHWiki 
articles on OSH national systems400). At EU level more than 40 sectoral Social Dialogue Committees 
and a cross-industry social dialogue committee is working on topics of EU-wide relevance.401  

In  the  frame  of  social  dialogue,  employer  federations  and  trade  unions  agree  on  the  regulation  of 
working  conditions  in  collective  agreements  without  intervention  or  close  reference  to  state 
regulations, for example, on working time or telework rules. The Eurofound ‘Database of wages, working 
time and collective disputes’ provides an EU-wide overview on such agreements.402 

In some countries, employers’ and workers’ associations are governing widely independent OSH 
institutions  (e.g.  Austrian  AUVA  or  German  Berufsgenossenschaften)  that  act  in  the  frame  of  state 
regulation but with quite considerable independent decision power.403 In some cases they dispose of 
significant  resources  and  are  major  players  for  some  areas,  like  training  of  OSH  professionals,  or 
compensation of occupational diseases. They can even implement financial incentives to initiate better 
OSH practices.404  

Management systems and policies contribute to better prevention; they include ethical considerations 
(corporate  responsibility  programmes,  sustainability  and  environmental  reports),  or  quality  objectives 
(quality management) particularly in global and large companies. Most of them cover all aspects of the 
business activities and OSH is one of these aspects. Well known are the standards of the International 
Organisation for Standardization (ISO), namely ISO  9001, Quality management systems, ISO 14001 
Environmental  management  systems  -  Requirements  with  guidance  for  use,  and  ISO  31000,  Risk 
management - Principles and guidelines. 405  

If the OSH aspects in such systems are not sufficiently covered, enterprises can introduce specific OSH 
management systems. ISO published the global standard ISO 45.000-2018 Occupational health and 
safety management systems - Requirements with guidance for use developed by ISO. According to ISO, 
these systems have the following function:  
‘OH&S management controls the conditions and factors that affect, or could affect, the health and safety 
of workers (including temporary workers and contractor personnel), visitors, or any other person in the 
workplace, to avoid their ill health and/or injury.’406 

Enterprises can also use other OSH management standards. At international level, the ILO published 
in 2001 ‘Guidelines on occupational safety and health management systems’.407 In EU Member States 
there exist several systems that target specific sectors or SMEs, for example, scorecard systems.408 
Critics of OSH management systems refer to the risk of a focus on ‘paper compliance’. 409 

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6.4  Prevention practices in enterprises  
It is widely acknowledged that in practically every regulated area there is a difference between the 
legal  prescription  and  the  practice.  Several  data  sources  and  background  reports  are  useful  to 
understand  these  differences  in  OSH. 410 The  most  comprehensive  overview  on  OSH  practices  in 
enterprises is done by EU-OSHA with its large survey ESENER.411 This survey provides information on 
how European workplaces are managing OSH in practice.  

In terms of the overall EU27 average scores, the most common reason reported for taking preventive 
action  was  ‘fulfilment  of  legal  obligations’  (85%  in  2014,  88%  in  2019),  followed  by  ‘meeting  the 
expectations  of  employees  or  their  representatives’  (79%  in  2014  and  81%  in  2019),  and  ‘avoiding 
fines or sanctions from the labour inspectorate’ (77% in 2014 and 79% in 2019). This latter point is 
interesting considering that ESENER 2019 reported a general decline in the number of establishments 
inspected, suggesting that fear of penalties is a sustainable driver.  
The complexity of legal obligations is still reported to be a major difficulty to address OSH by 41% of 
establishments in the EU27 (2019). The country breakdown shows a very diverse picture though, the 
highest shares being reported in Belgium and France (52% of establishments), as opposed to Latvia 
(14%), Lithuania (15%) and Finland (16%). While most factors report a slight drop in their respective 
shares  between  2014  and  2019,  a  lack  of  time  or  staff  shows  an  increase  from  27%  to  33%  being 
reported  as  a  barrier  to  OSH  management  in  15  out  of  the  19  sectors  (becoming  the  second  most 
reported  factor).  This  is  particularly  the  case  among  establishments  in  the  Netherlands  (39%), 
Luxembourg (36%) and Malta (33%).  

Lack  of  awareness  among  staff  is  regarded  by  18%  as  a  major  difficulty  and  by  35%  as  a  minor 
difficulty, in total 53%. When looking at size classes, minor and major difficulties are observed for 47% 
(size class 5-9), 55% (size class 10-49), 65% (size class 50-249) and 71% in enterprises with above 
250 employees. Compared to size class differences, the differences between sectors are small, and all 
are quite close to the average. 

Lack of awareness among management is mentioned by 36% (EU27), while 12% see it as a major 
difficulty and 24% as a minor difficulty. These differences between enterprise sizes quite remarkable: 
for the largest enterprises (50-249 and above 250), the percentages are the highest, about 44% and 
49%; the other two size classes range at or under the average of 36%. The differences between sectors 
are practically negligible.  

It  is  somewhat  surprising  that  a  lack  of  awareness  among  management  and  staff  seems  to 
increase with establishment size.  

The preparation of a document on health and safety responsibilities and procedures, which ideally 
should  be  made  available  to  employees,  is  clearly  reported  by  a  vast  majority  of  surveyed 
establishments in the EU27 (89% in both 2014 and 2019).  

Consistent  with  the  findings  in  2014,  a  total  of  75%  of  establishments  interviewed  in  the  EU27  in 
ESENER  2019  indicate  that  they  carry  out  risk  assessments  regularly.  As  expected,  there  is  a 
positive  correlation  with  establishment  size.  Several  national  studies  show  much  fewer  enterprises 
carrying out risk assessments, for example, only 50% in Germany, and SMEs even less.412 Moreover, 
only a small percentage of companies carry out workplace risk assessments that will not only meet the 
essential  procedural  requirements  but  also  take  into  consideration  new  and  emerging  risks  in  a 
comprehensive manner.413  

Particularly  difficult  is  the  assessment  of  the  quality  of  risk  assessments.  A  complete  quality 
assessment would require specific knowledge of several aspects: of the specific topic, of the — real — 
situation at the workplaces in an enterprise, and of the expected reduction of these risks by the proposed 
or  recommended  risk  mitigation  measures.  This  has  rarely  been  done.  Moreover,  even  inside  one 
enterprise  the  quality  of  a  risk  assessment  might  differ  depending  on  the  topic,  for  example, 
between ‘easier’ topics as ‘correct provision of warning signals’ or ‘adequate temperatures’, and more 
complex topics like psychosocial, musculoskeletal, or chemical and biological risks.414 

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If a risk assessment is conducted just for compliance purposes, and not used appropriately for the 
successful  management  of  OSH  and  reduction  of  accidents  and  occupational  diseases,  the  risk 
assessment may lose its dynamic nature, and findings may be neither implemented nor communicated 
appropriately to employees.  

The types of risks included in risk assessments are related to the risk profiles of different sectors, 
for example, it is likely that risk assessments in heavy industries and manual occupations focus more 
on safety risks. However, while sectoral risk profiles will naturally bias the identification of risks, smaller 
establishments seem to have less of a focus on MSDs or psychosocial risk factors, which would 
suggest that they are less well recognised or understood, in particular for MSEs.415 Establishments also 
report that psychosocial risk factors are more difficult to manage than other OSH risks, while as business 
size grows, so does the proportion of respondents who perceive psychosocial risks as more difficult to 
manage than other OSH risks.416 

ESENER  2019  shows  that  a  reluctance  to  talk  openly  about  these  issues  seems  to  be  the  main 
difficulty for addressing psychosocial risks (60% of establishments in the  EU27). This, as with all the 
other  difficulties  considered  (lack  of  awareness  among  staff/management  and  lack  of  expertise  or 
specialist support), is reported in all enterprise sizes but more frequently as establishment size grows.  

Specifically, among those establishments that report having to deal with difficult customers, patients or 
pupils,  51%  of  those  employing  20  or  more  workers  report  having  a  procedure  in  place  to  deal  with 
possible cases of threats, abuse or assaults by clients, patients or other external persons. This share 
rises to 74% among establishments in human health and social work activities. 

The  development  of  concrete  outputs  such  as  measures  to  better  manage  risks  that  can  result  in 
musculoskeletal diseases has actually seen a decline between 2014 and 2019, as follows: 

•  85% to 77% on the measure of ‘provision of equipment to help with the lifting or moving of loads 

or other physical heavy work’;417  

•  73% to 67% concerning ‘provision of ergonomic equipment’; and 
•  66%  to  60%  regarding  ‘encouraging  regular  breaks  for  people  in  uncomfortable  or  static 

postures including prolonged sitting’.418  

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The use of external sources of information to support with OSH management is relatively common 
across  the  EU27,  however,  the  type  of  organisational  expertise  received  varies  quite  significantly  by 
country, although, the most common source identified was ‘contracted OSH experts’ (64%), suggesting 
that  establishments  prefer  to  receive  advice  from  private  sources.  This  was  followed  by  insurance 
providers (45%), which in some countries, such as Germany (84%), forms a core element of the OSH 
management organisational system.  

Further to this, slightly under two-thirds of establishments in the EU27 (62%) report using the services 
of an external provider to support them in their health and safety tasks, the shares being highest among 
establishments  in  Slovenia  (86%)  and  Portugal  (85%).  Turning  to  external  providers  appears  to  be 
associated  positively  with  establishment  size  while  the  sector  breakdown  reveals  that  it  is  the  most 
frequent among establishments in manufacturing (72%).  

ESENER 2019 demonstrates that the use of health and safety services reveals occupational health 
doctors (76%), generalists on health and safety (61%), and experts for accident prevention (52%) to be 
the most frequently used. Focusing on psychosocial risks, the use of a psychologist is reported by only 
19% of establishments in the EU27, however significant differences can be observed between different 
countries. For example, in Finland the practice was indicated as widespread (from 60% to 71%), where 
a strong voluntary emphasis on managing mental health issues is places by national legislation. 419 

Concerning  forms  of  employee  representation,  a  health  and  safety  representative  was  the  most 
frequently reported figure: 57% of establishments in the EU27, slightly higher than in 2014. By sector, 
the  shares  were  highest  among  establishments  in  electricity,  gas,  steam  and  air  conditioning  (71%), 
education (67%), and mining and quarrying (67%). As expected, these findings are largely driven by 
establishment size.420  

the  appointment  of  the  health  and  safety 
ESENER  2019  asked  establishments  about 
representatives  and  the  findings  reveal  a  very  diverse  picture  across  countries,  in  reflection  of  the 
different national frameworks. More than half (52%) of establishments in the  EU27 report having the 
health  and  safety  representative  selected  by  the  employer,  the  highest  shares  corresponding  to 
Germany and the Czech Republic (83% of establishments), as opposed to Sweden, Finland and Italy 
(12%). On the other hand, substantially less than half of the surveyed establishments (38%) indicated 
that health and safety representatives are elected by the employees, the shares being highest in Finland 
and Italy (80%) and Sweden (75%).  

This reveals two  different  philosophies: in the first group of  Member  States, the employer selects an 
employee who has — or gets via training — a particular specialist knowledge in OSH, a representation 
of employees is not crucial for their selection, and the term ‘safety representatives’ is less adequate for 
this  group  than  ‘OSH  professional’  or  ‘OSH  practitioner’.  In  the  second  group  of  countries,  the 
representation of workers’ interest in OSH has priority, self-evidently these elected employees also have 
the right to specialist training in OSH. Mixed systems also exist.  

As in the past, there are significant differences when it comes to the share of establishments where risk 
assessments  are  mainly  conducted  by  internal  staff.  The  country  ranking  changes  significantly, 
being topped by Sweden (85% of establishments, up from 66% in 2014) and Denmark (80%, up from 
76%). The lowest shares are found in Slovenia (10%), Spain (10%) and Hungary (14%). While this does 
not conclude anything about the quality of these risk assessments in principle, in some countries there 
may be a legal obligation to contract OSH services for such tasks, and under the assumption that those 
in charge of the work are in the best position to control the risks, all enterprises should be able to carry 
out a basic risk assessment with their own staff only.  

A clear majority of team leaders and line managers in the EU27 receive training on OSH, although 
the trend has not advanced much (slightly over 70% of workplaces in the EU27). Moreover, there are 
notable  differences  in  the  extent  of  this  practice  between  countries,  suggesting  different  levels  of 
prioritisation  in  mandating  training  for  persons  with  OSH  responsibilities.  Unfortunately,  the  share  of 
respondents in the ESENER 2019 survey who have undergone OSH training declined slightly, from 71% 
in 2014 to 65% in 2019. ESENER is designed to collect information from the ‘persons most knowledge-
able about OSH in the establishment’, suggesting that training for persons with key responsibilities is 
decreasing slightly. 

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6.5  Conclusions  
Comprehensive EU legislation and its national transposition form the frame of OSH for enterprises 
and  are  the  base  for  national  legislations  and  governmental  approaches  and  actions  in  all  Member 
States. According to many studies in different countries, sectors and enterprise sizes, legislation is the 
key driver for preventive actions in enterprises. Moreover, the evaluations of EU OSH legislation show 
that the EU Directives are the ‘reference frame for national OSH regulatory regimes’.  

The  major  critical  issue  is  the  effective  and  qualitatively  substantive  implementation  of  the 
legislation  —  as  opposed  to  ‘paper’  compliance,  that  is,  the  preventive  quality  of  risk  reduction 
measures  at  the  workplace.  Evaluations,  expert  reviews  and  surveys,  analysing  the  practical 
implementation in Member States and the practice in enterprises (DG EMPL, EU-OSHA’s supporting 
compliance  reports,  ESENER,  SLIC  evaluations),  provide  evidence  about  the  current  situation,  the 
strength  and  weaknesses  of  implementation,  and  compliance.  EU  and  national  reports  show  a  high 
variety of enterprise practices and governmental actions. Examples from stakeholders, professionals 
and  practitioners demonstrate best, good, moderate  and  also  bad practices,  depending on company 
culture, size, sector and work task.  

The  trend  is  clearly  towards  a  higher  awareness  and  towards  a  wider  coverage  of  a  broader 
spectrum of risks. Support towards preventive measures is not only achieved by legislation but also 
by  stakeholder  support  of  multiple  kinds,  be  it  interactive  support  tools,  classical  guidance 
documents,  management  systems  or  European  product  standards.  They  all  help  to  better  cope 
with the complexity of risks and the selection of adequate preventive measures.  

However, the current data situation is still too diverse and the implementation of OSH legislation and 
guidance too different to assign a harmonised statement — or a kind of composite indicator — for 
effective implementation of legislation or standards, be it for Member States or for sectors or types 
of workplaces in the EU27. The quantity of risk assessments and preventive measures can be roughly 
estimated, based on ESENER and national surveys, but the quality of these risk assessments and the 
subsequent preventive risk reduction measures can only be assessed on a granular case-by-case level.  

This  difficulty  to  assess  a  kind  of  general  prevention  level  of  a  Member  State,  a  sector  or  an 
occupation  is  the  reason  why  ‘outcomes’  have  such  a  relevance  as  quantitative  indicators.  These 
indicators allow — although mostly being lagging indicators — an assessment on a highly aggregated 
level, like EU Member States, sectors or types of occupations. 

OSH Barometer – Steering of OSH Infrastructure, Enforcement Capacity (responsibility of Labour 
Inspectorates and similar state institutions, their powers, the scope of their work and their strategic 
planning): 
https://visualisation.osha.europa.eu/osh-barometer/osh-infrastructure/enforcement-
capacity/establishments-inspected 

ESENER – Data visualisation:  
https://visualisation.osha.europa.eu/esener/en/survey/datavisualisation/2019 

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7  Methodological approaches, available data and research 

questions 

7.1  The need for a detailed OSH information base  
Describing  the  state  of  OSH  in  the  EU  requires  reliable  data.  Many  national  and  European  OSH 
institutions and research institutes contribute to this data generation, covering a broad array of topics.421  

A reliable overview of the state of OSH is not an easy task, although the current information base is 
already broad: obligatory statistical data,422 EU-wide surveys, 423 and comprehensive reports and 
research on facts and figures, on policies, capacities and actions, provided by OSH institutions, 
agencies, universities and research institutes, professional organisations and international organisations 
(e.g. ILO, WHO and OECD). The EU sources range from quantitative datasets, for example, Eurostat 
statistics and large EU-wide surveys (e.g. ESENER,424 EWCS,425 LFS,426 Flash Eurobarometer 427), to 
detailed background reports on risks, OSH systems and infrastructures (e.g. by EU-OSHA, Eurofound, 
etc.) and evaluations and assessments of the level of implementation of OSH directives (e.g. by DG 
EMPL and by SLIC or surveys facilitated by the National Labour Inspectorates 428).  

The council Regulation (EC) No 2062/94 establishing EU-OSHA, mentions that: ‘the Agency's role shall 
be to […] collect and disseminate technical, scientific and economic information…’.429 In addition, the 
EU OSH Strategy 2002 to 2006 430 defined such work in a better information base explicitly as a major 
task of EU-OSHA: ‘The European Agency for Health and Safety at Work: - will set up a “risk observatory”, 
based on examples of good practice collected from firms or specific branches of activity; - will organise 
exchanges of experience and information by way of the systematic collection of data, with the support 
of Eurostat.’ Several publications from different periods document this approach. 431  

The need for better information and data is well known, as the EU Strategy 2007 to 2012 underlined: 
‘to  better  identify  and  assess  potential  risks  by  doing  more  research,  exchanging  knowledge  and 
applying  results  in  practice;  -  to  develop  monitoring  tools  to  track  progress;  ….432 The  EU  Strategic 
Framework  on  Health  and  Safety  at  Work  2014-2020  defined  seven  key  objectives,  where  key 
objective  6  requests  better  data:  ‘Improving  statistical  data  collection  to  have  better  evidence  and 
developing monitoring tools’. 433  

The most recent EU Strategic Framework on Health and Safety at Work 2021-2027 puts the focus 
on changes, with the title ‘Occupational safety and health in a changing world of work’.434 It emphasises 
the value of science-based evidence by stating: ‘Research and data collection, both at EU and national 
level, are a pre-condition for the prevention of work-related diseases and accidents. Scientific advice 
and the latest technological developments feed into OSH legislation and policy.’ 

These objectives show that good — and often more and better — evidence and monitoring tools are 
needed to understand all aspects of safety and health at work — as a pre-condition for priority setting 
and  effective  preventive  actions.  Consequently,  in  their  national  OSH  strategies,  a  good  number  of 
Member States have agreed on provision of better data as a major target. 435  

One example for such a monitoring exercise is EU-OSHA’s series of foresight studies, for example, on 
emerging risks in the healthcare sector, including home and community care, emerging accident and 
electricity risks in renewable energy jobs, cost of work-related stress and psychosocial risks, and also 
shorter expert  discussion papers, for example, on topics like nanotechnologies, robotics, 3D printing 
and use of performance-enhancing drugs in working life.436  

7.2  Quantitative data on OSH 
Quantitative data are the core of this report,  although the  authors are aware that  quantitative data 
finally gain their value by a well-considered qualitative description, including an analytical interpre-
tation of the reasons and context. Analysis aims to find answers to questions like: Why is this trend 
as it is, what are the reasons? Which data are available and which data do we not have but would like 
to? What do the data tell us about the need for action?  

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Eurostat is a major source of OSH-related statistics. First and foremost, Eurostat is responsible for the 
ESAW.437 In addition, approximately every six to eight years it adds an ad hoc module on OSH to its 
permanent LFS (1999, 2007, 2013, 2020).438  

Eurofound439 contributes substantially to the evidence on the state of OSH by its research on working 
conditions and industrial relations. The EWCS440 is based on interviews with more than 40,000 workers 
(2015) in all  EU Member States. The  interviewees respond to questions on the quality of their work, 
including  health  and  safety  issues  (every  five  years).  It  started  in  1991441 and  is  repeated  every  five 
years. Unfortunately, the EWCS 2020 had to be cancelled due to the pandemic situation. In 2021 it was 
conducted as a phone survey with a different approach, so the comparability of the results with previous 
surveys will be limited.  

EU-OSHA conducts every five years a similarly large survey on the practical management of OSH in 
enterprises, called The ‘European Survey of Enterprises on New and Emerging Risks - How European 
workplaces  manage  safety  and  health’  (ESENER). 442  Interviewees  are  those  managers  or  staff 
members  who  are  responsible  for,  or  most  closely  associated  with  OSH,  or  familiar  with  OSH.  This 
survey  provides  detailed  information  about  OSH  practices  in  enterprises  covering  more  than  30 
European countries. The ESENER methodology substantially changed between 2009 and 2014; in this 
report, trend descriptions are limited to the comparable surveys of 2014 and 2019. 

The Flash Eurobarometer is a large opinion poll on a large variety of topics related to EU policies and 
daily life in all EU Member States. In 1992 and 1996, two polls on Europeans and Health and Safety at 
Work gave some insights about the situation at that time.443 In 1997 and 2014, the poll questions were 
dedicated to working conditions,444 in 2018 the poll dealt with ‘Work Life Balance’445 and in 2020 with 
‘Undeclared work’.446  

The  text  box  below  contains  some  major  survey  data  to  illustrate  the  type  of  provided  data,  their 
development and the methodological changes.  

Survey figures from 1995 and 20 years later in 2014/2015 (1995 based on EWCS 2, 2015 based on 
EWCS 6 and on the Flash Eurobarometer 2014) 

1995: 29% of European workers think that their health could be affected by work (EWCS 2 Summary, 
p. 2) 
2015: 23% of European workers think that their health could be affected by work, minus 6% (EWCS 6) 

1995: 23% were absent from work due to a work-related health problem  (EWCS 2 Full Report, p. 290) 
2015: 45% were at least once absent from work due to a work-related health problem during the 
last 12 months, plus 22% (EWCS 6, EWCS data visualisation). Response to How many days were you absent from 
work for health reasons in the last 12 months? In the Flash Eurobarometer 2014 data (p. 75) 7% less, that is, 38% of the 
workers responded that they had an absence due to a health problem related to their work. 

1995: 13% had 10 and more days of absence (7% between 10 and 19 days, 6% more than 20 days 
289) 
(EWCS 
2015: 28% had more than five days of absence due to a health problem (EWCS 6 Overview Report, p. 112) 
Not fully comparable due to change of category  

Report, 

Full 

p. 

2 

1992: 14% consider a work accident a risk in their workplace (Eurobarometer 1992, Europeans and 
Health and Safety at Work, Synopsis). The question was skipped in 1995 due to the development of 
ESAW. 
2014: 6%/10% consider a work accident a risk in their workplace (Euro Flash Barometer 2014, p. 71 — 6% 
in  the  last  12  months  —  and  10%  during  ‘last  experience  of  work’,  p. 73.  This  is  8%/4%  less  compared  to  the 
Eurobarometer 1992. 

Many  governments,  that  is,  their  statistical  institutes  or  the  national  or  federal  OSH  institutes  of  EU 
Member  States,  perform  national  surveys  or  enquiries  on  working  conditions  and  analyse  data  from 
different  sources. 447  Furthermore,  data  are  collected  at  a  national  level  from  the  National  Labour 
Inspectorates, though in many cases they are not publicly available.  

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Also,  universities,  research  institutes  and  professional  associations,  for  example,  the  International 
Association of Labour Inspection (IALI),448 publish data on the national OSH situation, sometimes in a 
comparative perspective.  

In areas closely related to OSH, for example, in the fields of public health, pension and social insurance 
developments, industrial relations, labour law, aspects of OSH are often touched upon. This research is 
focused on data and analyses on the development of contract types, of wages, working times, and social 
insurance  systems  and  similar,  which  are  closely  connected  to  OSH. 449 Others  cover  the  relation 
between working and living conditions, including aspects like living styles, mobility, housing, childcare, 
elderly care. 

Particularly  during  the  last  decade,  publicly  available  dashboards  and  data  collections  have  been 
developed in many OSH-related areas. To mention some provided by EU institutions: the Cedefop 
Skills Panorama on the development of skill requirements and actual skills at European enterprises and 
work  places, 450 the  EIGE  Gender  Equality  Index, 451 the  ECHA  databases  on  workplace  exposure 
scenarios of chemical substances,452 the ECDC dashboards on communicable diseases,453 EMSA on 
safe work in the marine sector,454 the FRA reports on severe labour exploitation of migrants and survey 
on violence against women,455 and the European Monitoring Centre for Drugs and Drug Addiction on 
the  use  of  traditional  and  modern  drugs  at  work  places. 456 The  European  Commission  Directorate-
General for Health and Food Safety (DG  SANTE) provides  indicators and data  on health status and 
health systems.457 Although the core objectives of the data collections and analysis of these institutions 
do  not  specifically  include  work,  working  conditions  or  OSH,  many  of  their  results  shed  a  light  on 
particular aspects of health and safety at workplaces.  

Many national surveys and statistical evaluations add to this, often with more detail and closely related 
to the national economic and political infrastructure and its working conditions legislation. The different 
national  situations  to  which  the  institutes  refer  to  and  the  different  methodologies  that  the  national 
institutions  use  make  it  hard  to  impossible  to  compare  countries  based  on  these  national  data. 458 
However, the differences seem to be minor if the questions in European or national surveys are very 
similar.  

‘Second,  when  the  surveys  do  include  similar  questions,  the  responses  seem  to  be  similar  across 
surveys. This was illustrated with a question on overall satisfaction with the working conditions and/or 
overall job satisfaction. Such a question is included in the EWCS as well as the German BIBB/BAuA 
survey and the NWCS in the Netherlands. It was shown that findings from the national surveys are very 
similar  to  findings  from  the  EWCS,  which  indicates  that,  at  least  for  this  question,  methodological 
differences between the surveys do not lead to different findings. While this implies that the integration 
of the datasets is in theory possible, the problem remains that the national surveys share few questions 
that are exactly the same, in addition to the methodological challenges highlighted above’.459 

Also,  international  institutions  provide  information  that  covers  in  some  cases  all  but  often  only  a 
selection  of  EU  Member  States.  These  are,  for  example,  the  OECD,  which  publishes  overarching, 
general  and  country  reports  on  economic  and  sectoral  developments,  and  on  infrastructures  of  the 
health system. International organisations like the ILO and its data collections and ‘National profiles on 
occupational safety and health’460 contribute to the richness of data. The WHO and its Regional Office 
for Europe provide global, regional (large groups of countries) and national data in its ‘Global Health 
Observatory’.461 Both the UN organisations are first of all committed to a global approach, but they also 
publish specific country profiles or specific data for countries or regions.  

Despite these many data collections, there are still important data and research deficits that leave 
room for less unambiguous and more speculative interpretations of the state of OSH.462 The reporting 
of working conditions in official statistics (administrative data, registry-based data) and voluntary surveys 
cannot cover all aspects of OSH at workplaces. The accuracy of statistics and surveys fades as more 
informal and irregular working conditions are prevalent. Work at the edges of legality is surely not a good 
base for the willingness to respond realistically in interviews or to provide reliable statistical data. Other 
issues add to this, for example, low participation of migrants in voluntary surveys is reported by many 
survey providers.463  

These types of  less formalised work have gained  more  and more  importance in social reality  and 
research.  There  are  some  prominent  examples  of  EU-wide  overviews.  The  ‘European  Platform  for 

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tackling undeclared  work’  provides fact sheets of the type and  quantity  of undeclared work in  all  EU 
Member States;464 Eurofound published several reports on platform work,465 and the FRA had a series 
of publications and fact sheets on severe cases of  exploitation, particularly of  migrant workforces.466 
Also,  the  creation  of  the  European  Labour  Authority  (ELA) 467 is  partly  a  consequence  of  the  often 
irregular working conditions of mobile, posted, contracted or seasonal workers who leave their 
country to work in the EU or in another European country. ELA particularly aims to mitigate such critical 
issues related to labour mobility and social security coordination between countries. 

In this report, the quantitative data and the interpretation of the developments will cover — in an ideal 
case  —  the  period  2005  to  2020.  In  2004,  a  major  extension  of  the  EU  took  place,  from  15  to  25 
Member States. If it is not possible to cover the whole period, the analysis is limited to the maximum 
possible period. If comparability is high, for a very few selected data a further look back to the 1990s 
was taken.  

Moreover,  there  can  be  major  comparability  difficulties  caused  by  the  change  of  methodological 
approaches,  geographical  coverage  and  other  context  factors  during  the  last  10  to  30  years.  Major 
challenges for comparative assessments of EU-wide harmonised data collections from different years 
were:  

•  The EU went through several enlargement processes, expanded from EU-12 to EU-15 in 
1994, expanded from EU-15 to EU-25 in 2004, to EU27 in 2007 and to EU28 in 2013, and 
from 2020 on — due to the departure of the United Kingdom — the EU consists of 27 Member 
States. In statistical publications the identifier EU27_2020 is often used to distinguish this 
period from the EU27 phase between 2008 and 2012, before Croatia joined and the EU27 
became EU28.  

•  Methodologies of data collection changed, questions in surveys were abandoned or 

changed, and sample sizes or structures changed, for example, the given period in survey 
questions changed. One example is from the EWCS: the time categories for health-related 
absence from work changed from ‘between 10 and 20 days’ to absence of ‘more than 15 
days’.  
Important structural decisions were taken in the sector of economic statistics, like the 
change of the statistical composition and the coding of economic sectors, NACE Code 1, 
Revision 1 (NACE 1.1) was applied until 2007, and from 2008 NACE Code 2 is applied.  

• 

•  The survey providers use(d) for occupation and educational attainment different 

categories and aggregations levels, for example, ESEG, ISCED or ISCO. 

•  Some important categories and definitions are not fully harmonised in statistics, for example, 

the definition of ‘manual worker’ or of ‘migration status’.468  

7.3  Qualitative data and research 
Quantitative data gain importance by a comprehensive description of the reasons behind these 
data  and  their  development,  by  interpretation  and  analysis.  Such  analytical  explanations  are 
elaborated by (roughly categorised): the providers of the quantitative data themselves, in addition by 
scientists at universities and governmental institutions, by European, national or regional governmental 
organisations,  by  business  federations  and  trade  unions,  by  professional  associations  and  by 
international organisations.  

This analytical work covers a large variety of topics like detailed studies and reports on risks, exposures 
and  outcomes,  on  the  development  and  application  of  effective  technical  and  organisational 
preventive measures, on preventive OSH systems and infrastructures, for example, evaluations and 
assessments of the level of implementation of OSH directives, and finally on the societal, economic 
and legal frame and context of OSH.  

There  is  no  strict  separation  between  the  following  four  types  for  research  categories.  For 
example, the EU-OSHA study ‘Analysis of the determinants of workplace occupational safety and health 
practice in a selection of EU Member States’ 469 includes an analysis of the systems and infrastructures 
as well as of the framework and context influence. To fully cover understanding and support of OSH 
prevention in workplaces, all these types of research are needed. 

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Research on risks, exposures and outcomes including future developments 

This type of data and research deals with the description and analysis of risks and exposures and 
health outcomes (there are basically three outcomes: 1) work accidents, 2) diseases, and 3) wellbeing 
/ job satisfaction / overall perception of health at work), and their interlinkage. Risk identification  and 
exposure assessment relates to several types of risks and exposures: mechanical, physical, chemical 
or biological risks, including those risks caused by the circumstances at workplaces (e.g. those technical 
basics listed in the Directive on minimum safety and health requirements for the workplace470), and risks 
caused  by  the  work  organisation,  including  aspects  like  work  intensity  and  time  pressure,  poor 
communication  and  misunderstanding,  harassment  and  discrimination  and  work  with  clients  and 
customers. All these topics are subjects of a wider field of different sciences, ranging from engineering 
and natural sciences to psychology and sociology to several medical disciplines. 471  

Similar methodological considerations were also essential for EU-OSHA to initiate a worker survey on 
workplace  exposures  to  carcinogens  and  occupational  cancer  (2020  to  2024). 472 Reliable  and 
publicly available exposure data are rare for many typical daily work situations. It is for this reason that 
EU-OSHA has chosen an approach that relies on an expert system, that is, it connects the description 
of workplaces and work tasks to exposure estimates of probable occurrence of and exposure to certain 
carcinogenic substances.  

A specific section of this research is the foresight on the development of risks at workplaces. Major 
trends  are  analysed  regarding  their  impact  on  OSH;  these  can  be  trends  like  digitalisation  including 
aspects like robotics, AI virtual work environments, globalisation including aspects like OSH in supply 
chains  or  migration,  green  transformation  including  aspects  like  circular  economy,  demographic 
changes with aspects like ageing, and public health developments like diseases related to prolonged 
sitting.473 

Research on effective technical and organisational preventive measures 

Based on these predominantly ‘diagnostical findings’, an often separated strain is the development of 
preventive measures. Engineering and natural sciences mainly deal with the development of preventive 
technical measures to avoid accidents and limit health-impairing impacts. This technical OSH research 
includes the development or improvement of preventive technologies, of safe and healthy products and 
processes at workplaces, a regulation, a practical guidance or standard setting.  

Social sciences (organisational sociology, occupational psychology and similar) are active in developing 
preventive  measures  for  organisational  risk  factors.  They  develop  best  practice  models  and 
contribute  to  guidance  and  standards,  as  well  as  background  data  and  evidence  for  legislation 
regulations and good practices of awareness raising and intervention.  

OSH systems and infrastructures  

The preventive effectiveness of OSH systems and infrastructures in enterprises and at state level is 
another  major  research  field.  These  studies  often  focus  on  qualitative  assessment,  for  example,  the 
assessment  of  the  performance  and  effectiveness  of  such  systems  and  infrastructures  (e.g. 
DG EMPL, IALI474). They often cover not only enterprises (employers and workers) and the government 
but also the wider OSH infrastructure, for example, professional associations and research institutes.  

Research about prevention practices and processes in enterprises 475 covers aspects like awareness 
raising, supporting and hindering factors to initiate preventive activities,476 the impact of guidance 
and instructions for workers, training and education of OSH professionals, including concrete regulations 
of  their  functions  and  responsibilities  in  enterprises,  their  dependencies  and  relations  to  the 
management  and  to  workers,  and  the  role  of  legislation  and  state-based  systems  for  prevention  in 
enterprises, or the quality of risk reduction measures.  

Research on the societal, economic and legal frame and context  

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The development of society, be it economically, legally or culturally, influences OSH. These studies also 
cover the impact of OSH on society, for example, costs of work-related diseases for society,477 or the 
relations between work (or occupation) and socioeconomic status. 

This influence of such context developments on OSH is described in specific studies, for example, 
on types and levels of implementation of legislation,478 on social insurance developments, the influence 
of globalisation on supply chains and services, the ageing workforce, the ageing of the society causing 
the approach to care for elderly people as long as possible at their homes, and development in related 
policy fields like public health. It is mainly a field for humanities such as economy, sociology or law.479 

Meanwhile, a stronger connection between OSH and other policy and research fields has emerged. 
OSH  research  extended  its  frame  and  objectives  to  ethical  considerations,  for  example,  regarding 
research on corporate social responsibility or on working conditions in the supply chain.480 Moreover, 
environmental policies influence safety and health at workplaces, for example, regarding the use of 
safe  but  environmentally  harmful  chemicals,  emissions  from  enterprises  to  air,  soil  and  water,  and 
energy consumption. Public health institutions provide research results about the connection between 
work and personal lifestyles, be it smoking or physical inactivity, adaptation of workplaces, and return 
to  work  programmes  in  collaboration  with  social  security  or  professional  and  non-profit 
organisations. 

7.4  Data and research – major evidence difficulties at EU level  
A precise and — in some cases even an approximate — assessment of the state of OSH is by far 
not  an  easy  task. 481 Often,  different  explanations  and  reasons  for  similar  developments  are  given, 
diverging or opposite developments in some countries are not well explained, and finally we can observe 
— for the same topic or situation — also a highly positive and highly negative assessment of the state 
of OSH in general or of several aspects, simply because there are no data that all stakeholders accept 
as reliable. One example might be the level of compliance: estimates of the number of breaches of 
OSH  legislation  and  the  responsibility  for  these  breaches  will  often  differ  between  employers  and 
workers.  

As  mentioned  already,  several  groups  are  hard-to-reach  in  surveys  or  other  types  of  research,  for 
example,  migrants,  seasonal  and  posted  workers  due  to  language  issues  and  ‘cultural’  and 
contract  insecurity,  and  workers  in  irregular  circumstances,  but  also  workers  with  a  legal 
exemption from several OSH regulations, for example, self-employed, often military and police and 
some  parts  of  the  public  sector.  Literature  and  analysis  adds  to  these  ‘old-hard-to-reach’  groups  of 
workers the ‘new-hard-to-reach’, which are mainly characterised by new types of contracts, a less clear 
employer / employee role, and/or mobile and remote work.482  

There surely is also a bias of responses regarding socially not-at-all or not-well-accepted topics like 
undeclared work or personal behaviour, for example, taking cognitive or performance-enhancing drugs 
at work. 

Some structural factors make an unambiguous and accurate assessment of the state of OSH in the EU 
particularly difficult: 

1) 

2) 

3) 

4) 

the variety of OSH systems and infrastructures in EU Member States and its impact on 
(harmonised) EU-wide data collection and research approaches; 
the issues related to the use (or even new development) of reliable and measurable 
indicators, the methodological differences between different survey and research 
approaches; 
the assessment of the effectiveness of preventive actions and the evaluation of the 
quality and quantity of outcomes, injuries and diseases; and 
the continuous development and structural changes of working conditions and the social, 
economic and technological context of OSH. 

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7.4.1  Variety of OSH systems 

In  the  EU  Member  States  there  exists  a  considerable  variety  of  working  conditions  and  related 
prevention and monitoring systems, as well as a variety of OSH traditions, OSH cultures regarding risk 
awareness and preventive safety measures, different types of responsibilities of state institutions, and 
a variety of social dialogue schemes between employers’ and workers’ associations.  

Moreover,  practically  all  EU  OSH  legislation  is  issued  as  European  Directive,  not  as  European 
Regulation. These directives set minimum standards that allow Member States to specify many details 
related  to  their  national  situation.  In  addition,  in  many  fields  already  existing  national  legislation  was 
aligned in different ways with EU OSH directives.  

Consequently,  the  understanding  and  assessment  of  OSH  at  an  EU  level  causes  methodological 
problems,  for  example,  regarding  the  methods  of  data  collection,  the  application  of  indicators, 
harmonisation  of  monitoring  approaches,  and  of  terminology,  recognition  of  work-related 
diseases,  comparison  of  different  infrastructures,  and  even  the  technical  measurement 
standards.  

It is not easy to apply data and research generation methodologies that are on one side well harmonised 
and  on  the  other  side  give  room  to  understand  the  functioning  and  value  of  different  systems  and 
infrastructures.  Some  trends  seem  to  be  general  and  obvious,  and  some  Member  States  or  some 
sectors or enterprises can experience no trend at all in this direction, or even the contrary development. 
Structural developments can differ significantly between countries. Of relevance seems to be the intra-
EU  exchange  of  workforce,  based  on  ongoing  changes  in  production  chains.  The  main  flow  of  the 
workforce takes place — roughly described — from eastern and southern Europe to central, western 
and northern Europe.483  

Example: Working conditions – contrary trend developments in EU Member States  

‘The  magnitude  –  and  sometimes  the  direction  –  of  these  sectoral  changes  varies  from  one  country 
cluster to another. An increase in physical routine tasks in a few sectors, and a decline in cognitive tasks 
in the other services sector can be observed in Eastern countries. These changes are partly linked to a 
reorganisation of the value chain within Europe, which saw a reallocation of routine tasks from western 
European countries.’ 

Eurofound, 2020: Working conditions in sectors, p. 41 

7.4.2  Reliable and measurable indicators  

Several indicators are used to assess and estimate the quality and effectiveness of the preventive 
systems  and  processes.  Not  only  the  EU  but  also  other  countries  have  introduced  such  indicator-
based monitoring systems, for example, Norway,484 South Korea,485 Japan, 486 Taiwan,487 Singapore, 488 
United States,489 Canada,490 Australia 491 and New Zealand.492 

The responsible institutions or authorities in these countries often developed several types of indicator, 
for example, indicators for implementation of protective legislation, for system effectiveness as well as 
for  health  outcomes.  International  organisations  have  also  developed  such  monitoring  indicators,  for 
example, the ILO,493 the ILO in its OSH country profiles,494 the WHO495 and the UN496 (see textbox). 

United Nations, Sustainable Development Goals – Indicators for Target 8.8 
Target 8.8 Protect labour rights and promote safe and secure working environments for all workers, 
including migrant workers, in particular women migrants, and those in precarious employment 
Indicator 8.8.1: Frequency rates of fatal and non-fatal occupational injuries, by sex and migrant status 
Indicator 8.8.2: Level of national compliance of labour rights (freedom of association and collective 
bargaining) based on ILO textual sources and national legislation, by sex and migrant status 

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Eurostat has developed under the lead of UNECE a framework to assess the quality of employment in 
its multiple facets.497 Eurostat describes this framework as set of 68 indicators 498 on seven dimensions 
‘that address employment quality from the perspective of the employed person. Its design also facilitates 
international comparisons.’499 OSH is covered under the section ‘Safety’ and is based on four indicators 
and  includes  two  outcome  and  two  risk  indicators:  1)  Fatal  occupational  injuries  /  Number  of  fatal 
accidents at work (excluding traffic accidents); 2) Non-fatal occupational injuries / Number of non-fatal 
accidents at work; 3) Exposure to physical health risk factors; and 4) Exposure to mental health risk 
factors. Eurostat implements the OSH parts of this framework by its ESAW and by the OSH-related ad 
hoc modules to the LFS, called ‘Accidents at work and other work-related health problems’ (surveys in 
2007, 2013 and 2020).  

For more detailed monitoring at EU level, DG EMPL/ACSH and EU-OSHA developed a structural model 
that uses four groupings: Generic information on the basics of the OSH systems and on major context 
factors like age or sectoral structure, main policies for the Steering of OSH, an overview on relevant 
Working conditions and Prevention, and Outcomes, that is, accidents, diseases and wellbeing, and 
some elements of the OSH infrastructure and monitoring capacity. Currently, the OSH Barometer 
works with 16 quantitative and qualitative indicators in these four groupings. Some of these indicators 
are purely descriptive, like the short descriptions of OSH authorities, OSH institutions or OSH-related 
surveys, and others allow qualitative comparisons of structures and policies, for example, the indicator 
on ‘National strategies’ or ‘Social dialogue’. Many indicators, for example, on working conditions or work 
accidents,  are  based  on  quantitative  data  from  surveys  and  statistics.  These  indicators  allow  a 
comparison between sectors, occupations, types of enterprises, countries, for example.  

CHAPTERS 

INDICATORS 

Generic information 

Indicator: OSH authorities (descriptive) 

Indicator: Economic and sector profile (quantitative) 

Indicator: Workforce profile (quantitative) 

Steering of OSH 

Indicator: Regulation (descriptive) 

Indicator: National strategies (descriptive)  

Indicator: Social dialogue (descriptive, composite indicator) 

Working conditions and prevention 

Indicator: Working conditions (quantitative) 

Indicator: Prevention in companies (quantitative) 

Indicator: Worker involvement (quantitative) 

Indicator: OSH culture and health awareness (quantitative) 

Accidents, diseases and wellbeing 

Indicator: Work accidents (quantitative) 

Indicator: Work-related diseases (quantitative) 

Indicator: Health perception of workers (quantitative) 

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OSH infrastructure and monitoring capacity 

Indicator: Enforcement capacity (descriptive) 

Indicator: OSH statistics and surveys (descriptive) 

Indicator: International organisations / programmes (descriptive) 

During this development, other indicators were discussed but excluded due to complexity, necessary 
granularity  and  likely  required  effort,  for  example,  compensation  and  insurance  systems  (of  work 
accidents  and  diseases),  preventive  capacities  and  services  in  and  outside  enterprises,  training  and 
education capacities for OSH practitioners and professionals, OSH research capacities, OSH networks, 
major guidance and support offers for enterprises.  

7.4.3  Relationship between preventive actions and outcomes 

It can be difficult to demonstrate a causal relationship between working conditions and health 
and  safety  outcomes,  (outcomes  =  accidents  including  traffic  and  near-accidents,  work-related 
diseases or the level of wellbeing), that is, a reliable cause-effect relationship. Generally, in the field of 
safety such a relation can be much easier identified (accidents ► injuries) than in the field of health, in 
almost all cases an injury is an immediate consequence of an accident at work.  

Scientists  and  practitioners  have  also  often  determined  clear  connections  between  prevention 
actions and outcomes, also between certain exposures and recognised occupational diseases, 
and between types and quality of safety instructions and the occurrence of accidents. 500 

Still,  there  exist  many  less  visible  and  statistically  hard-to-detect  relations  between  working 
conditions,  preventive  actions  and  accidents,  and  health  and  workplace  wellbeing,  and  very 
specific research and knowledge is needed to describe and analyse them more in detail. Most important 
are the confounding context factors, for example, the reduction of work accidents in a sector might be 
strongly  influenced  by  context  developments,  for  example,  economically  induced  sector  shifts,  or 
important technological changes.501 In addition, health and wellbeing are influenced by other aspects of 
working conditions, like working time or contractual security. 

Moreover, due to effective preventive work, extreme exposures at work that in the past often led to a 
recognised  occupational  disease  have  been  mitigated,  reduced  or  even  eliminated  by  preventive 
measures and/or technological changes. Some examples are very loud noise, specific permanent tiring 
postures,  very  heavy  loads,  extreme  dust  and  fume  exposure,  and  reduction  or  elimination  of  well-
studied highly toxic chemical substances. In short, preventive measures — in particular if legally required 
—  contributed  to  an  overall  reduction  of  the  number  of  workers  exposed  to  extremely  ‘unhealthy’ 
workplace exposures.  

7.4.4  On the way to better evidence – major data, research gaps and open 

questions  

This report used EU-OSHA reports, foresight studies and reviews, and several EU-wide surveys and 
statistics on working conditions, namely ESENER, EWCS, Eurostat’s statistical data, the Eurostat LFS 
and its Ad hoc modules, the Flash Eurobarometer, academic reviews, and data and reports from EU 
institutions or EU agencies like DG EMPL, DG SANTE, Eurofound, EIGE, FRA, Cedefop, ECHA and 
from  international  organisations  like  the  ILO,  WHO,  OECD,  ICOH,  UN  and  UNEP.  These  statistics, 
surveys  and  reports  mostly  apply  a  harmonised  EU-wide  or  international  approach  to  make  the 
situation in different countries comparable.  

Many more national statistics and surveys on working conditions exist, often with a higher level of 
detail, but they are rarely used for a comparative view, due to the inevitable methodological differences. 
Costly research work would be needed to cover all relevant national studies and monitoring data in all 
EU languages and conclude from these overviews on the situation in the EU27.  

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Some important questions remain at the end of such a report:  

•  The quality of statistics and surveys fades the more irregular are the working conditions 
being studied. Which research methods are adequate for a clearer and more reliable evidence 
base on these working conditions? It might require research methods different from those used 
today,  for  example,  more  investigative  case  studies;  it  might  also  be  helpful  to  evaluate  the 
existing national working conditions surveys or statistics under this aspect. 

•  Fading employer–employee relations. There are special research efforts necessary to study 
the application of OSH regulations of work with weak or no employer–employee relations, for 
example, for the self-employed and new forms of employment.  

•  Surveys usually suffer a participation bias, for example, for the migrant workforce. The 
low participation rate of migrants can contribute to a particular underestimation regarding their 
often unfavourable working conditions.  

•  Workers in manual occupations report better health than administrative workers but less 
expectations to do the job until being 60 years old. What are the reasons behind this? Is it 
the  healthy  worker  effect,  strong  occupation-related  differences  regarding  the  perception  of 
health and the expression of health problems? 502,503 

•  High work intensity is a major cause for low wellbeing and high psychosocial risks. Survey data 
suggest that work intensification stopped after 2005. What might be the reasons? Are the 
current indicators not specific enough to measure developments of work intensity? Has since 
then  the  major  burden  of  intensification  been  put  on  other  types  of  workers,  for  example, 
subcontracted or self-employed, temporary and seasonal workers, or on workers in the global 
supply chain?  

•  How much evidence is there that dangerous work has been increasingly contracted out to 
small and medium-size enterprises and the self-employed? Are there sufficiently detailed 
data  on  whether  a  larger  share  of  service  and  client-related  work  at  atypical  times  or  work 
requiring long working hours has been taken over by self-employed or subcontractors? 

• 

•  The  influence  of  enterprise  size  is  often  difficult  to  explain.  In  several  aspects,  the  SMEs 
perform better, and in other important aspects worse. What might be the reason for this?  
•  How is it possible to overcome the ‘prevention gap’ that in general exists between mobile 
and stationary workplaces? Can the solutions be technical or must there be organisational 
and legal measures, for example, a limitation of the prolonged use of ergonomically inadequate 
equipment like mobile phones? 
Impact of international and global supply chains on OSH: Does it improve or worsen the 
working conditions in the EU? Research could try to estimate the risk-reducing impact of the 
shift  of  some  high-risk  productions  to  enterprises  outside  the  EU,  for  example,  mining,  base 
chemicals, recycling and so on (export of risks), and to estimate the OSH impact of EU export 
production, for example, vehicles, specialty chemicals, machines for risks at work inside the EU 
(import of risks). 
It would also be a big step forward if research could achieve an agreed standard value or a 
standard range (as reliable as possible) for the attributable fraction of work to widespread 
diseases, that is, cardiovascular diseases, mental and behavioural disorders, musculoskeletal 
diseases and cancer.  

• 

•  Compliance  with  and  impact  of  legislation.  Currently,  there  are  data  on  the  percentage  of 
enterprises with a risk assessment but very limited information about the quality of these risk 
assessments  and  of  implemented  risk  management  and  reduction  measures.  Previous 
studies indicate that in many cases the risk assessment is conducted by an enterprise just to 
comply with legal obligations (paper compliance). A possible approach could be an anonymous 
evaluation of the quality of a representative share of risk assessments. 

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References and notes 

1 OSH Barometer data visualisation tool: https://visualisation.osha.europa.eu/osh-barometer 

2 Methodological remark: Many workers in the service sectors have similar physically demanding work like workers 
in  manufacturing,  construction  and agriculture.  The  statistical  assignment  of  enterprises of  a certain  type  to the 
service sectors and the sectors industry/construction/agriculture is a too rough approach to describe and analyse 
working conditions, particularly if more detailed data on working conditions are available. For that reason, when 
talking about health outcomes, in this report often more informative categories are used, for example, managerial 
jobs (LFS, Eurostat terminology), or high-, medium- and low-skilled clerical work (EWCS), or high-skilled manual 
and low-skilled manual work (Eurostat), independent on the sector where this work is performed. 

3 EU-OSHA – European Agency for Safety and Health at Work: Third European Survey of Enterprises on New 
and Emerging Risks (ESENER 3), ESENER Data visualisation, section ‘Comparisons 2014-2019’; for ‘Prolonged 
sitting’ value from ‘Data visualisation 2019’ not from ‘Comparisons’. 
4 Some of the very first OSH regulations on psychosocial risks at workplaces were issued by Denmark in the early 
1980s, dealing with monotony at work, stress, risk of violence at work and risks of working alone. 
5 Psychosocial risks are regarded as reason, and mental health/disease as consequence or outcome of these 
risks. 

6 OSHWiki, 2022: Psychosocial issues – the changing world of work; OSHWiki, 2022: Psychosocial risks and 
workers health 

7 EU-OSHA, 2007: Expert forecast on emerging psychosocial risks related to occupational safety and health  
8 Eurofound, 2017: Sixth European Working Conditions Survey – Overview report (2017 Update) (p. 48). Raw 
data for 2015: Eurofound: European Working Conditions Survey - Data Visualisation; Data for 2005: Eurofound: 
Fourth European Working Conditions Survey 
9 EU-OSHA: ESENER Data visualisation, Comparisons 2014-2019. 
10 Due to the change of possible response items, the data for the three surveys cannot be compared; the number 
of mental risk factors increased from three in 2007 and 2013 to eight in 2020. 
11 Eurostat, 2021: EU labour force survey 2020 module on accidents at work and other work-related health 
problems : assessment report : 2021 edition 

12 Eurostat: Persons reporting exposure to risk factors that can adversely affect mental well-being by sex, age and 
factor, data here and explanatory metadata here 
13 It has to be noted that in 2007 and 2013 the interviews were done face-to-face. In 2020 the interviews were 
conducted either face-to-face or by phone, depending on the public health measures in each country. The 
responses were influenced by work under conditions of the pandemic. 

14 Eurostat: Persons reporting exposure to risk factors that can adversely affect mental well-being by sex, age and 
educational attainment level 

15 Rigó et al., 2021: Work stress on rise? Comparative analysis of trends in work stressors using the European 
working conditions survey 
16 WHO/ILO, 2021: WHO/ILO joint estimates of the work-related burden of disease and injury, 2000–2016: Global 
monitoring report (p. 35ff). 

17 Eurostat provide data for the periods before and after the NACE revision in 2008. Data for 2019: Average number 
of  usual  weekly hours  of  work  in  main  job, by sex,  professional  status,  full-time/part-time  and economic activity 
(from 2008 onwards, NACE Rev. 2), here Filter: Full-time, 15-64 years, all NACE sectors. Data for 2006: Average 
number of usual weekly hours of work in main job, by sex, professional status, full-time/part-time and economic 
activity (1998-2008, NACE Rev. 1.1), here 

18 Eurostat, 2018: How many hours do Europeans work per week? Average number of usual weekly hours of work 
in main job, by sex, professional status, full-time/part-time and economic activity (from 2008 onwards, NACE Rev. 
2) - hours[lfsa_ewhun2], here 

19 Mean duration of commuting time one-way between work and home by sex and age (source: Eurofound), Here 

20 Eurostat definition: The atypical work distinguishes between “evening or night work”, “Saturday or Sunday 
working”, and “shift work”. Data for 2020 are available but indicate a strong reduction of atypical working times, 
the reason is probably that sectors with a high rate of atypical working times like tourism, transport, entertainment, 
hotels and restaurants could not work as in previous years, and also production lines in industry, often shift work, 
were stopped. 

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21 Eurostat: Ad hoc module 2019 on work organisation and working time arrangements. Employment at an 
atypical working time (time period start with 2011), here and here 

22 Eurostat Data for 2019: Average number of usual weekly hours of work in main job, by sex, professional status, 
full-time/part-time and economic activity (from 2008 onwards, NACE Rev. 2). here Filter: Employees, Full-time, All 
NACE, EU27 2019 Q4.  
Eurostat Data for 2006: Average number of usual weekly hours of work in main job, by sex, professional status, 
full-time/part-time and economic activity (1998-2008, NACE Rev. 1.1), here Filter: Employees, Full-time, All 
NACE, EU27 2019 Q4. 
23 Eurostat definition of atypical work: The atypical work distinguishes between “evening or night work”, “Saturday 
or Sunday working”, and “shift work”. 
24 All data were retried from tables in: Labour market > Employment and unemployment (Labour force survey) M 
> LFS series - detailed annual survey results M > Population in employment working during unsocial hours - LFS 
series 
25 Eurostat: Employed persons working at nights as a percentage of the total employment, by sex, age and 
professional status (%) 
26 Eurostat: Employed persons working on Sundays as a percentage of the total employment, by sex, age and 
professional status (%) 
27 Fiz Perez et al., 2019: Shift and night work management in European companies 
28 OSHWiki, 2022: Psychosocial issues – the changing world of work 
29 Eurofound, 2003: Time and work: Work intensity  
Eurofound, 2009: Working conditions in the European Union: Working time and work intensity 
30 Eurofound, 2017: Sixth European Working Conditions Survey – Overview report (2017 Update) (p. 48). 

31 ESENER addresses the person in an enterprise responsible for or closest to the topic of OSH; the EWCS is a 
worker survey. In addition, the response options were different from the EWCS. Two options in ESENER, ‘Yes’ or 
‘No’, compared to three options in the EWCS: ‘(Almost) all of the time’, ‘Between ¼ and ¾ of the time’, ‘(Almost) 
never’. 

32 EU-OSHA: Third European Survey of Enterprises on New and Emerging Risks (ESENER 3), ESENER Data 
visualisation, section ‘Comparisons 2014-2019’, section ‘Psychosocial risk factors present in the establishment’, 
‘Pressure due to time constraints’. 
33 Ibid., Section ‘Psychosocial risk factors present in the establishment’, ‘Long or irregular working hours’. 
34 Ibid., Section ‘Psychosocial risk factors present in the establishment’, The exact question was: ‘Please tell me 
for each of the following risks whether or not it is present in the establishment?‘ ‘Pressure due to time constraints’. 
Response option: Time pressure. 
35 Ibid., Section ‘Psychosocial risk factors present in the establishment’, The exact question was: ‘Please tell me 
for each of the following risks whether or not it is present in the establishment?‘ ‘Pressure due to time constraints’. 
Response option: Time pressure. 
36 EU-OSHA: Third European Survey of Enterprises on New and Emerging Risks (ESENER 3), ESENER Data 
visualisation, section ‘Comparisons 2014-2019’, section ‘Psychosocial risk factors present in the establishment’, 
The exact question was: ‘Please tell me for each of the following risks whether or not it is present in the 
establishment?‘ ‘Pressure due to time constraints’. Response option: Time pressure. 

37 Eurostat, 2019: Persons in employment by frequency of working under time pressure, educational attainment 
level and professional status, 20-64 years, percentages calculated from numerical data 

38 Kelliher & Anderson, 2010: Doing more with less? Flexible working practices and the intensification of work 
39 Piaska, 2018: Scheduled to work hard: The relationship between non-standard working hours and work 
intensity among European workers (2005–2015) 
40 See also the overview in: EU-OSHA, OSHWiki, Guyot, S: Psychosocial issues – the changing world of work, 
here 
41 Newer literature: James & Walters, 2022: Work and Health: 50 Years of regulatory failure. 
42 Davis & Kim, 2015: Financialization of the Economy 
43 Ethics & Compliance Initiative, 2020: Global Business Ethics Survey Report. Pressure in the Workplace: 
Possible Risk Factors and Those at Risk 
44 Johnstone et al., 2005: Statutory Occupational Health and Safety Workplace Arrangements for the Modern 
Labour Market 

45 Lorenz & Valeyre, 2005: Organisational Innovation, Human Resource Management and Labour Market 
Structure: A comparison of the EU-15 

46 Directive 2003/88/EC of 4 November 2003 concerning certain aspects of the organisation of working time 

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47 Adăscăliței et al., 2021: The intensification of work in Europe: A multilevel analysis 

48 EU-OSHA, 2002: Report - New forms of contractual relationships and the implications for occupational safety 
and health (p. 7). 

49 Eurofound, 2011: Impact of subcontracting on working conditions 

50 Koranyi et al., 2018: Precarious employment and occupational accidents and injuries – a systematic review 
51 ILO Indicator description: Occupational injuries 
52 See the diagrams and country data in the OSH Barometer under: https://visualisation.osha.europa.eu/osh-
barometer/  
53 Tynes et al., 2017: Physical working conditions as covered in European monitoring questionnaires 
54 EU-OSHA: Third European Survey of Enterprises on New and Emerging Risks (ESENER 3) – first findings, 
2019, p. 3 and ESENER Data visualisation, section ‘Comparisons 2014-2019’, section ‘Risk factors present in the 
establishment’, Export data 
55 EU-OSHA calculations based on EWCS raw data. 
56 Eurostat, LFS Ad hoc modules: Persons reporting exposure to risk factors that can adversely affect physical 
health by sex, age and factor 
57 In the LFS-survey the respondents had to decide which of 11 possible risk factors is the most ‘serious one’. 
Quote: ‘Eurostat proposed to implement the exposure to risk factors for physical health at work by using one 
question that strictly reflects the variable or twelve questions asking for the presence of any of the eleven risk 
factors and then ask for the most serious one.’ 
In the EWCS and ESENER all reported risk factors were registered. 

58 EU-OSHA,  2020:  Work-related  musculoskeletal  disorders:  why  are  they  still  so  prevalent?  Evidence  from  a 
literature review  

59 EU-OSHA,  2020:  Work-related  musculoskeletal  disorders:  why  are  they  still  so  prevalent?  Evidence  from  a 
literature review 

60 OSHWiki, 2020: Musculoskeletal disorders and prolonged static sitting 
61 EU-OSHA, 2010: Maintenance and Occupational Safety and Health: a statistical picture 
62 Marin-Garcia et al., 2020: Changes in the Association between European Workers’ Employment Conditions and 
Employee Well-Being in 2005, 2010 and 2015 (p. 9). 
63 Balogh et al., 2021: Non-standard employment and mortality in Belgian workers: A census-based investigation 

64 Gallagher & Underhill, 2012: Managing work health and safety: recent developments and future directions 
(p. 238).  
My Business, n.d.: WHAT IS A ‘PERSON CONDUCTING A BUSINESS OR UNDERTAKING’? 

65 Employment by sex, age and professional status (1 000), quarterly data, Eurostat employment types; 
Employment and activity - LFS adjusted series - historical data (1989-2020), Total employment, annual data, here  
Part-time: here and here  
Temporary: here and here  
Contract with a limited duration, 15-64 years, here 
66 Eurostat definitions: EU Labour Force Survey - Methodology 

67 OECD, 2019: Pensions at a Glance 2019, OECD and G20 Indicators  
Quote: ‘Non-standard work is frequent among workers over 65 and women Non-standard work is common among 
older workers. While overall employment rates decrease at older ages, the share of non-standard work is 
particularly high among workers over 65: only about 15% of workers between 65 and 74 are in standard 
employment, against more than 60% at ages 55-64 and 25-54 (Figure 2.2, Panel A)’ (p. 70). 

68 Eurofound, 2021: Seasonal worker  
‘A seasonal worker is defined in Article 3(b) of Directive 2014/36/EU on the conditions of entry and stay of third-
country nationals for the purpose of employment as ‘a third-country national who retains his or her principal place 
of residence in a third country and stays legally and temporarily in the territory of a Member State to carry out an 
activity dependent on the passing of the seasons, under one or more fixed-term work contracts concluded directly 
between that third-country national and the employer established in that Member State.’ European Parliament and 
the Council: Directive 2014/36/EU of 26 February 2014 on the conditions of entry and stay of third-country 
nationals for the purpose of employment as seasonal workers. 
69 Action Plan EU: Seasonal workers are a group of mobile workers who retain their main place of residence in 
their home country and move temporarily to another Member State to carry out an activity dependent on the 
passing of the seasons, here  
Article 2.1. ‘This Directive shall apply to third-country nationals who reside outside the territory of the Member 

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States and who apply to be admitted, or who have been admitted under the terms of this Directive, to the territory 
of a Member State for the purpose of employment as seasonal workers.’ here (p. 6). 
Molinero Gerbeau & González Ferrer, 2018: EU DIRECTIVE ON SEASONAL WORKERS  
These data are partly unreliable, to quote: ‘Member States can decide what they consider as “seasonal workers” 
because there is no common definition and numerical instrument allowing to evaluate the same phenomenon 
making data on EU’s seasonal workers incomparable within countries. The Polish case is very illustrative of the 
deficiencies of the actual European statistical system where, for instance, real data on seasonal workers for 
certain countries coexist with data on the number of Declarations received under the Polish Declaration System 
that are just intentions to hire foreigners, but not effective work or residence permits.’ (p. 4) 
Definition of seasonal worker in DIRECTIVE 2014/36/EU OF THE EUROPEAN PARLIAMENT AND OF THE 
COUNCIL of 26 February 2014 on the conditions of entry and stay of third-country nationals for the purpose of 
employment as seasonal workers. 
70 De Wispelaere et al., 2022: Posted workers in the European Union - Facts and figures 
71 European Commission, 2020: COVID-19: Guidelines of the Commission on seasonal workers in the EU. 
Factsheet on practical examples and best practices 
72 OECD, 2019: Pensions at a Glance 2019, OECD and G20 Indicators (p. 67).  
73 OECD, 2019: Pensions at a Glance 2019, OECD and G20 Indicators (p. 69). 
74 OECD, 2019: The Sharing and Gig Economy: Effective Taxation of Platform Sellers: Forum on Tax 
Administration or Employment outlook. 

75 Eurofound, 2020: New forms of employment: 2020 Update 

76 A first approach to use administrative data: Balogh et al., 2021: Non-standard employment and mortality in 
Belgian workers: A census-based investigation 
77 Please note that the working conditions of important groups of non-standard work could not sufficiently be 
covered in this chapter, e.g. for seasonal workers, migrant workers, second jobs of students, employees and 
pensioners, and self-employed. The main reason for this is that quantitative EU-wide data on the OSH situations 
of these groups are rare or not reliable due to missing statistics or surveys. There are numerous qualitative 
reviews and case studies about these groups, and a detailed description would go beyond the frame of this 
report.  

78 Directive 89/654/EEC concerning the minimum safety and health requirements for the workplace excludes five 
types of work, to quote: ‘This Directive shall not apply to: (a) means of transport used outside the undertaking and 
/or the establishment, or workplaces inside means of transport; (b) temporary or mobile work sites; …’. 

79 Directive  90/270/EEC  of  29  May  1990  on  the  minimum  safety  and  health  requirements  for  work  with  display 
screen equipment (fifth individual Directive within the meaning of Article 16 (1) of Directive 89/391/EEC), here 

80 EU-OSHA’s maintenance campaign revealed that maintenance and repair work has an accident risks far over 
average. EU-OSHA, 2010: Safe maintenance in practice (p. 10): ‘Occupational accidents during maintenance 
work are numerous. Based on the data from several European countries, it is estimated that 10-15% of fatal 
accidents at work, and 15-20% of all accidents, are connected with maintenance.’ 
81 No statistical data available for EU.  
82 Persons in employment by main place of work, frequency of working at other locations and working from home, 
LFS Ad hoc module: Work at home, percentage of Employed persons 
83 Eurostat: Working from home in the EU 
84 LFS Ad hoc module Work at home, percentage of Employed persons and LFS regular data collection Employed 
persons working from home as a percentage of the total employment  
85 EU-OSHA, 2021: Home-based teleworking and preventive occupational safety and health measures in 
European workplaces: evidence from ESENER-3 
86 Employed persons working from home as a percentage of the total employment, by sex, age and professional 
status (%), here 
87 There are more workers who spend most of their working time in private homes, e.g. technicians for 
maintenance and repair of technical systems like heating water supply or electricity, or gardeners. According to 
the ILO definition of domestic work they are not regarded as such. Care at home can be borderline if the care is 
mainly done for a few persons in a few homes. 
88 C189 European Alliance, 2021: Step up efforts towards decent work for domestic workers in the EU: 10th 
Anniversary of ILO Domestic Workers Convention, 2011 (No. 189)  
See there in the introductory chapter the difficulties to achieve reliable figures. For more info: ILO, 2021: Making 
decent work a reality for domestic workers: Progress and prospects ten years after the adoption of the Domestic 
Workers Convention, 2011 (No. 189) 
89 EU-OSHA, 2020: Well-being at work in the service voucher sector in Belgium 

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90 Eurofound, 2020: Long-term care workforce: Employment and working conditions  
Eurostat: National accounts employment data by industry (up to NACE A*64): Growth from 7.4 million in 2008 to 
9.5 million in 2019, here Filter [Q87_Q88] Residential care activities and social work activities without 
accommodation. 

‐

91 LTC definition by the Social Protection Committee and European Commission, 2014: Adequate social 
protection for long–term care needs in an ageing society (p. 11): ‘a range of services and assistance for people 
who, as a result of mental and/or physical frailty and/or disability over an extended period of time, depend on help 
with daily living activities and/or are in need of some permanent nursing care. The daily living activities for which 
care activities that a person must perform every day (Activities of Daily Living, or 
help is needed may be the self
ADLs, such as bathing, dressing, eating, getting in and out of bed or a chair, moving around, using the toilet, and 
controlling bladder and bowel functions) or may be related to independent living (Instrumental Activities of Daily 
Living, or IADLs, such as preparing meals, managing money, shopping for groceries or personal items, 
performing light or heavy housework, and using a telephone).’ 
92 Eurofound, 2020: Long-term care workforce: Employment and working conditions (p. 27). 
93 Eurofound, 2020: New forms of employment: 2020 Update (p. 9). 
94 See for example the KOMNET Helpdesks https://www.komnet.nrw.de/  
95 European Commission, 1996: Guidance on risk assessment at work (Directive 89/391/EEC)  
96 Besamusca & Steinmetz, 2019: Vulnerable groups in European data sets. An inventory of the measurement of 
vulnerable groups in 27 data sets covering the European area. They write (p. 5): ‘A further challenge with respect 
to vulnerability and employment vulnerability is the question to which level it applies. To individuals and/or groups 
(with particular characteristics which increases the vulnerability risk), a situation (in which a person/group finds 
themselves which increase the vulnerability risk, like for instance precarious work), or whether this is a more 
universal concept which applies to all people as human beings, as everybody could become at one point in time 
‘vulnerable’ and depending upon the state for our well-being (Fineman, 2008).’ 
97 OSHWiki, 2022: Groups at risk 
EU-OSHA, 2003: Gender issues in safety and health at work. A Review 
98 European Parliament, 2011: Occupational health and safety risks for the most vulnerable workers, Study  
Fasani & Mazza, 2020: A Vulnerable Workforce: Migrant Workers in the COVID-19 Pandemic (p. 1). 
99 Browse Gender Statistics | Gender Statistics Database | European Institute for Gender Equality (europa.eu) 

100 In the technical area of OSH, female workforce was often not taken as standard, concerning equipment, 
machinery or PPE: the standards were aligned and designed for standard men. 

101 EU-OSHA, 2007: Report - OSH in figures: Young workers - Facts and figures 
102 EU-OSHA: Women and safety and health at work 
103 EU-OSHA: Women at Work: An Introduction 
104 Eurostat: Accidents at work by sex and severity (NACE Rev. 2 activity Total), here  
Eurostat: Persons reporting a work-related health problem by sex, age and country of birth, here 
105 Eurostat: Time spent, participation time and participation rate in the main activity by sex and educational 
attainment level, here 
106 EU-OSHA, 2016: The ageing workforce: Implications for occupational safety and health - a research review – 
Executive Summary (pp. 4-5). 
107 EU-OSHA, Themes Ageing & OSH: OSH management in the context of an ageing workforce 
108 Andersen et al., 2020: Barriers and opportunities for prolonging working life across different occupational 
groups: the SeniorWorkingLife study 
109 Eurostat: Accidents at work by sex, age and severity (NACE Rev. 2 activity A, C-N), here 
110 Eurostat: Non-fatal accidents at work by NACE Rev. 2 activity and age, here 
111 European Parliament, 2011: Occupational health and safety risks for the most vulnerable workers, Study (p. 
29). 
112 EU-OSHA, 2018: Management of psychosocial risks in European workplaces : evidence from the second 
European survey of enterprises on new and emerging risks (ESENER-2) 
113 EU-OSHA, 2018: Foresight on new and emerging occupational safety and health risks associated with 
digitalisation by 2025 
114 Wellbeing is often measured as composite indicator covering several aspects of work, for example, in the 
WHO-5 Well-Being index. 
115 Incidence rate = number of work accidents per 100,000 workers. The number of EU Member States changed 
significantly in 1995 from (EU-12 to EU-15) and 2004 (from EU-15 to EU-25). That is the reason why we use here 
the incidence rate from ESAW as indicator and not the total number. 

116 Eurostat: Statistics in focus, Theme 3-16/2001: Accidents at work in the EU 1998-1999 (p. 2). 

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117 Eurostat, Accidents at work by sex and severity (Sector A, C-N, NACE Rev. 2, EU27). Only incidence rates for 
these selected sectors can be compared, because Eurostat did not calculate / publish an incidence rate for all 
sectors in 1998 but for Sector A and D to K, NACE 1.1). The incidence rate for all sectors is a little bit lower in 
2019 (1,603) because the other sectors have lower accident risks. That would also have been the case in 1994.  

118 Eurostat: Accidents at work by sex and severity (NACE Rev. 2 activity Total). 
119 Eurostat: Statistics in focus, Theme 3-16/2001: Accidents at work in the EU 1998-1999 (p. 3). 

120 Eurostat: Fatal Accidents at work by NACE Rev. 2 activity (HSW_N2_02), filter for sectors Sector A, C-N, 
NACE 2. 

121 Eurostat: Accidents at work by sex and severity (NACE Rev. 2 activity Total). 

122 Eurostat: Non-fatal accidents at work by NACE Rev. 2 activity and sex 

123 Eurostat: Fatal Accidents at work by NACE Rev. 2 activity; Fatal Accidents at work: Mining and quarrying 
124 Rees, 2016: Comparing European and American Health & Safety Laws – ‘Pre-1970, there were approximately 
14,000 worker fatalities a year, according to the Occupational Health and Safety Administration (OSHA). By 2010, 
the workforce had doubled, but fatalities were down to just 4,500 – a workplace fatality rate reduction of 66 
percent. Worker injuries and illnesses were also down from 10.9 incidents per 100 workers in 1972 to 3.2 per 100 
in 2014.’ 
125 WHO/ILO, 2021: WHO/ILO joint estimates of the work-related burden of disease and injury, 2000–2016: 
Global monitoring report (p. 18). 
126 Source of the picture: here (copyrighted). 
127 Eurostat: Accidents at work, by specific physical activity and economic activity, EU, 2019 (% share).  
128 Eurostat: Businesses in the mining and quarrying sector  
129 European Commission: Textiles and clothing in the EU 
130 European Parliament, 2014: Briefing – Workers’ conditions in the textile and clothing sector: just an Asian 
affair? 
131 Eurostat: National accounts employment data by industry (up to NACE A*64), Filter for years and sector 
‘Agriculture, forestry and fishing’, here  
132 World Bank: Employment in agriculture (% of total employment) (modelled ILO estimate)  
https://data.worldbank.org/indicator/SL.AGR.EMPL.ZS?end=2018&most_recent_year_desc=true&start=1991&typ
e=shaded&view=chart  
133 United Nations – e-Waste coalition: Global E-waste Monitor 2017 
134 For example: OSH system at national level - France 
135 Eurostat, 2013: European Statistics on Accidents at Work (ESAW) - Summary methodology - 2013 edition 
(p. 5).  
136 Eurostat: Non-fatal accidents at work by NACE Rev. 2 activity and sex, A recalculation of the total number of 
accidents for the EU27 to the years 1994 to 1998 is not possible, mainly due to the many enlargements of the EU. 
137 Eurostat, Statistics in focus, Theme 3 – 16/2001: Accidents at work in the EU 1998-1999 (p. 4), here 
138 Data for 1998 for the Sectors A and D to K, NACE Rev. 1.1, EU-15, for 2019 for Sectors A, C-N, NACE Rev. 2, 
EU27. Only incidence rates for these selected sectors can be compared because Eurostat did not provide an 
incidence rate for all sectors in 1998 but for the sectors A and D to K, NACE 1.1. 
139 In total the incidence rate decreased from 4,089 to 1,713; the difference is 2,376. The reduction between 1998 
and 2010 amounts to 2,068, and between 2010 and 2019 it sums up to 308. That means that 87% of the 
reduction was achieved in the first period and 13% in the second period.  
140 Eurostat: Non-fatal accidents at work by NACE Rev. 2 activity and sex, Filter Sectors, A, C-N  
141 Eurostat: Accidents at work statistics – Incident rates 
142 Eurostat: Non-fatal accidents at work by NACE Rev. 2 activity and sex, Filter: Time frequency: Annual; Unit of 
measure: Incidence rate; Classification of economic activities - NACE Rev. 2; Sex: Total. 
143 EU-OSHA, 2010: A review of methods used across Europe to estimate work-related accidents and illnesses 
among the self-employed 
144 EU-OSHA, 2010: A review of methods used across Europe to estimate work-related accidents and illnesses 
among the self-employed (p. 7). 
145 Eurostat, 2013: European Statistics on Accidents at Work - Summary methodology - 2013 edition (p. 6): 
‘Article 2 of the ESAW Regulation covers the provision of data on persons who had an accident at work during the 
reference period and states that if the victim is self-employed, a family worker or a student, providing data is 
voluntary.’ 

146 Eurostat: Non-fatal accidents at work by NACE Rev. 2 activity and sex 

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147 In 2019, there were 3.141 million non-fatal accidents that resulted in at least four calendar days of absence 
from work and 3,408 fatal accidents in the EU27, a ratio of approximately 922 non-fatal accidents for every fatal 
accident, here  
148 Kurppa, 2015: Severe Under-reporting of Work Injuries in Many Countries of the Baltic Sea Region: An 
exploratory semi-quantitative study – ‘What goes unreported goes unfixed’ (p. 20 ff). 

149 Eurostat: Non-fatal accidents at work by NACE Rev. 2 activity and sex; Eurostat: Fatal Accidents at work by 
NACE Rev. 2 activity 

150 Detailed studies from hospitals in Denmark show that even a large share of serious work accidents (25%) 
resulting in amputations and fractions are not registered, see: LO Denmark, 2012: Underrapportering af 
arbejdsulykker Table 14; and the Danish Working Environment Authority published a report concluding a total of 
50% in underreporting, here 
151 Kurppa, 2015: Severe Under-reporting of Work Injuries in Many Countries of the Baltic Sea Region: An 
exploratory semi-quantitative study – ‘What goes unreported goes unfixed’ (p. 20ff). 
152 LFS Ad hoc module: Accidents at work and other work-related health problems (2020, 2013 and 2007)  
153 Eurostat: EU labour force survey 2020 module on accidents at work and other work-related health problems : 
assessment report : 2021 edition. The exact question is (p. 47): ‘Thinking of the year before [last day of reference 
week], have you had any accident at work? Accidents outside working hours and accidents during the journey 
from home to work or from work to home are excluded. However, accidents during a journey in the course of work 
are included.’ 
154 Eurostat, Statistics in focus, Theme 3 – 16/2001: Accidents at work in the EU 1998-1999, here 
155 ISCO-Groups: 1. Managers, 2. Professionals, 3. Technicians and Associate Professionals, 4. Clerical Support 
Workers, 5. Services and Sales Workers, 6. Skilled Agricultural, Forestry and Fishery Workers, 7. Craft and 
Related Trades Workers, 8. Plant and Machine Operators and Assemblers, 9. Elementary Occupations, 0. Armed 
Forces Occupations. 

156 Eurostat: Persons reporting an accident at work by sex, age and occupation  

157 Eurostat, 2021: Self-reported accidents at work - key statistics 

158 Ibid. 

159 Agilis, 2015: Final statistical report on the quality assessment and statistical analysis of the 2013 Labour Force 
Survey ad hoc module (p. 45) 

160 Eurostat, 2013: European Statistics on Accidents at Work (ESAW) - Summary methodology - 2013 edition 
(p. 6). 
161 Fatal work accidents are seen as a more reliable data source than non-fatal accidents. 
162 Eurostat: Fatal accidents at work by NACE Rev. 2 activity, Filter: Incidence rate. 

163 The OSH Barometer shows the ESAW data from Eurostat’s Fatal accidents in a column diagram showing the 
incidence rate per 100,000 workers for two periods, here  

164 Communication from the Commission to the European Parliament, the Council, the European Economic And 
Social Committee and the Committee of Regions on the practical implementation of the provisions of the Health 
and Safety at Work Directives 89/391 (Framework), 89/654 (Workplaces), 89/655 (Work Equipment), 89/656 
(Personal Protective Equipment), 90/269 (Manual Handling of Loads) and 90/270 (Display Screen Equipment), 
here (p. 15). 
165 European Commission, 2009: Causes and circumstances of accidents at work in the EU (p. 101 and Table 
A1.6. p. 130). 

166 ESAW Data for 2019: Eurostat, Accidents at work by sex, age and severity (NACE Rev. 2 activity A, C-N).  
167 In publications about this topic, we find similar coefficients. Eurogip calculates for France (2016) 514 fatal 
accidents and 34,202 cases with permanent disability, this is a coefficient of 66 (Eurogip, 2018: Statistical review 
of occupational injuries - France 2016 data). Calculating a similar coefficient for Germany in 2018 leads to a 
coefficient of 27 based on the relation of 497 fatal accidents to 13,550 recognised permanent handicaps that are 
compensated by an occupational pension (DGUV, 2021: Geschäfts- und Rechnungsergebnisse der gewerblichen 
Berufsgenossenschaften und Unfallversicherungsträger der öffentlichen Hand 2020, Anhang 1, p. 164). 
Jørgensen calculates based on Eurostat data from 2009 and 2010 a coefficient of fatal accidents to disabled 
people of 18, and when she calculates the coefficient between fatal and ‘most serious non-fatal injuries’ of more 
than three months, the coefficient is 41. Jørgensen, 2015: Serious work accidents and their causes - An analysis 
of data from Eurostat 
168 EU-OSHA, 2019: The value of occupational safety and health and the societal costs of work-related injuries 
and diseases (Table A4b, pp. 112-113). 

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169 ‘Presence’ means according to the Eurostat ESAW methodology 2013: ‘Presence of the victim or of a third 
person in itself creating a danger for oneself and possibly others’ (p. 28). 
170 European Commission, 2009: Causes and circumstances of accidents at work in the EU (p. 106). 
171 The DIFR is defined as the total number of reported disabling and fatal injuries per 1 million hours worked. 
See: Government of Canada, 2021: 2019 Annual Report - Occupational Injuries amongst Employees Under 
Federal Jurisdiction (9.39 per 1 million hours worked). 
172 Safe Work Australia, 2021: Comparative performance monitoring report 23rd edition (p. 12ff) (3.6 claims per 
1,000 employees). 
173 Franco, 2012: Bernardino Ramazzini and women workers’ health in the second half of the XVIIth century 
174 Ramazzini, 1713: De morbis artificum diatriba (p. 199ff). Latin original text: ‘Infortunium ergo, quod huiusmodi 
Artificibus ex suis opificiis, praeter vitae sedentaria incommoda, est Myopia, affectus nempe oculorum satis notus, 
cum scilicet visibilia oculis propius admovere necesse est.’ 
175 EU-OSHA, 2019: The value of occupational safety and health and the societal costs of work-related injuries 
and diseases  
176 ILO Encyclopaedia: Work-related Diseases and Occupational Diseases: The ILO International List 
177 European Commission, 2013: Report on the current situation in relation to occupational diseases’ systems in 
EU Member States and EFTA/EEA countries, in particular relative to Commission Recommendation 2003/670/EC 
concerning the European Schedule of Occupational Diseases and gathering of data on relevant related aspects, 
here 

178 Examples from national recognition schemes: Arbetsmiljöstatistik Rapport 2021:01. Arbetsskador 2020 
Occupational accidents and work-related diseases; Germany: DGUV, 2021: DGUV, 2021: Geschäfts- und 
Rechnungsergebnisse der gewerblichen Berufsgenossenschaften und Unfallversicherungsträger der öffentlichen 
Hand 2020  

179 Eurostat (Statistics explained): Occupational diseases statistics 
180 Eurostat: European occupational diseases statistics (EODS) and EU index of occupational diseases 
(2013=100) – experimental statistics 
181 European Federation of Building and Woodworkers (EFBWW), 2013: Asbestos
in Central and East European Countries (p. 11). 
182 See for example, the ILO List of Occupational Diseases Recommendation R194, revised 2010. 

‐

related occupational diseases 

183 European Commission, 2018: Scientific Committee on Health, Environmental and Emerging Risks SCHEER - 
Statement on emerging health and environmental issues, here see pp. 9-10. The SCHEER refers to this article: 
Holden et al, 2016: Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050 

184 European Commission, 2022:  
https://ec.europa.eu/social/main.jsp?langId=en&catId=89&furtherNews=yes&newsId=10463 
185 EU-OSHA, 2021: Executive summary - Musculoskeletal disorders: association with psychosocial risk factors at 
work 

186 Eurostat: Life expectancy by age and sex, here  
187 OECD/European Union, 2020: Health at a Glance: Europe 2020: State of Health in the EU Cycle (p. 112, 
p. 116).
188 OECD/European Union, 2022: Health at a Glance: Europe 2022: State of Health in the EU Cycle (p. 87ff).
189 Eurostat: Life expectancy by age and sex
190 Eurostat: Life expectancy by age and sex

191 OECD/European Union, 2020: Health at a Glance: Europe 2020: State of Health in the EU Cycle (p. 120). 

192 OECD/European Union, 2022: Health at a Glance: Europe 2022: State of Health in the EU Cycle (p. 95ff). 
193 Joumard et al., 2008: Health Status Determinants: Lifestyle, Environment, Health Care Resources and 
Efficiency 
194 Mazeikaite et al., 2021: What Drives CrossCountry Health Inequality in the EU? Unpacking the Role of 
Socioeconomic Factors 
195 Eurofound, 2017: European Quality of Life Survey 2016 - Overview Report 
196 Eurostat: Self-perceived health by sex, age and income quintile 
197 Eurofound, 2017: European Quality of Life Survey 2016 - Overview Report (p. 18). 
198 Eurostat’s ‘Morbidity Task Force’ is working on this: Archive:Morbidity statistics methodology pilot studies – 
examples, here; and, Eurostat: Morbidity statistics in the EU - Report on pilot studies - 2014 edition, here  
199 Pace & Buchow, 2014: Morbidity Statistics in the EU – key results from pilot studies in sixteen Member States 
200 More detailed country data are available in the Eurostat section on Health in the European Union – facts and 
figures Country Health Profiles, here 
201 European Commission: European Core Health Indicators  

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202 Mazeikaite et al., 2021: What Drives CrossCountry Health Inequality in the EU? Unpacking the Role of 
Socioeconomic Factors  

203 Eurostat: LFS 2020 Ad hoc module, here 

204 Eurostat: Persons reporting a work-related health problem by sex, age and occupation, here 

205 Murray & Lopez, 1996: The Global burden of disease : a comprehensive assessment of mortality and disability 
from diseases, injuries, and risk factors in 1990 and projected to 2020, here 

Update: GBD 2017 Risk Factor Collaborators, 2018: Global, regional, and national comparative risk assessment 
of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and 
territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017, here 

206 European Burden of Disease Network 
207 WHO definition: ‘One DALY represents the loss of the equivalent of one year of full health. DALYs for a 
disease or health condition are the sum of the years of life lost to due to premature mortality (YLLs) and the years 
lived with a disability (YLDs) due to prevalent cases of the disease or health condition in a population.’ here 

208 Murray & Lopez, 1996:. The Global burden of disease : a comprehensive assessment of mortality and 
disability from diseases, injuries, and risk factors in 1990 and projected to 2020, here 

209 IHME/GDB: GDB Compare - Vizhub, Visualisation of global health data, here 

210 Takala et al., 2017: Comparative Analysis of the Burden of Injury and Illness at Work in Selected Countries 
and Regions  
Ezzati et al., 2004: Comparative quantification of health risks: global and regional burden of disease attributable to 
selected major risk factors  
Nelson et al., 2005: The global burden of selected occupational disease and injury risks: Methodology and 
summary 

211 WHO: Protecting workers’ health, Key facts  
212 Pneumoconiosis: a group of lung diseases resulting from inhalation of particles of industrial substances, 
particularly inorganic dusts. 

213 IHME (Institute for Health Metrics and Evaluation) (2016). Rethinking development and health: 
http://ghdx.healthdata.org/gbd-results-tool?params=gbd-api-2016-
permalink/7193a516026f9a7df17cf73ea9ce3a5d Findings from the Global Burden of Disease Study. Seattle, WA: 
IHME. IHME Database.  

214 WHO/ILO, 2021: WHO/ILO joint estimates of the work-related burden of disease and injury, 2000–2016: 
Global monitoring report 
215 Ibid., pp. 55-56. 
216 WHO/ILO, 2021: WHO/ILO joint estimates of the work-related burden of disease and injury, 2000–2016: 
Global monitoring report (p. 18). 
217 The figures of the working age population of 16 years and above are based on EU-OSHA calculations of data 
provided by the United Nations World Population Prospects database: United Nations, Department of Economic 
and Social Affairs, Population Division (2019). World Population Prospects 2019, Online Edition. Rev. 1., File 
POP/1-1: Total population (both sexes combined) by region, subregion and country, annually for 1950-2100 
(thousands), here 
218 WHO, Occupational Burden of Disease Application, https://who-ilo-joint-
estimates.shinyapps.io/OccupationalBurdenOfDisease/ and EU-OSHA calculations 
219 International Commission on Occupational Health (ICOH) data based on new and until today unpublished 
calculations: Takala et al.: Comparative Global Estimates on the Work-related Burden of Accidents and Diseases 
(preprint) 
220  WHO, Occupational Burden of Disease Application, https://who-ilo-joint-
estimates.shinyapps.io/OccupationalBurdenOfDisease/ and EU-OSHA calculations 
221 WHO/ILO, 2021: WHO/ILO joint estimates of the work-related burden of disease and injury, 2000–2016: 
Global monitoring report (pp. 55-56). 
222 WHO applied for the global estimates as reference the population with an age above 15 years. At EU level, 16 
years — probably even older — is the minimum age to start work or an apprenticeship. 
223 WHO, Occupational Burden of Disease Application, https://who-ilo-joint-
estimates.shinyapps.io/OccupationalBurdenOfDisease/ and EU-OSHA calculations 

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224 Pega et al., 2022: Global, regional and national burden of disease attributable to 19 selected occupational risk 
factors for 183 countries, 2000–2016: A systematic analysis from the WHO/ILO Joint Estimates of the Work-
related Burden of Disease and Injury, ￼here 
225 Kauppinen et al., 1998: Occupational exposure to carcinogens in the European Union in 1990-1993: 
international information system on occupational exposure to carcinogens, here  
CAREX Canada  
Fevotte et al., 2011: Matgéné: A Program to Develop Job-Exposure Matrices in the General Population in France  
Mannetje et al., 2011: Developing a general population job-exposure matrix in the absence of sufficient exposure 
monitoring data 

226 YLDs = years lived with disability, together with YLLs = years of life lost, it composes the DALY (DALY = YLL + 
YLD). 

227 GBD 2019 Mental Disorders Collaborators, 2022: Global, regional, and national burden of 12 mental disorders 
in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019, 
here  
228 WHO: Mental disorders, Key facts and  
IHME: Global Health Data Exchange (GHDx), here 
229 OECD, 2015: Sick on the Job?: Myths and Realities about Mental Health and Work 
230 OECD/European Union, 2018: Health at a Glance: Europe 2018: State of Health in the EU Cycle 
231 Andlin-Sobocki et al., 2005: Cost of disorders of the brain in Europe  

232 Niedhammer et al.; 2021: Update of the fractions of cardiovascular diseases and mental disorders attributable 
to psychosocial work factors in Europe, here  

233 Norder et al., 2017: Beyond return to work from sickness absence due to mental disorders: 5-year longitudinal 
study of employment status among production workers, here 
234 Leka & Jain, 2017: EU Compass for Action on Mental Health and Well-Being - Mental Health in the Workplace 
in Europe 
235 Musculoskeletal disorders refer to backache and/or muscular pains in shoulders, neck, upper limbs and/or 
lower limbs (hips, legs, knees, feet, etc.). In the medical systematic it is the IC 10 group of diseases: Diseases of 
the musculoskeletal system and connective tissue. 
236 EU-OSHA, 2019: Work-related musculoskeletal disorders: prevalence, costs and demographics in the EU 
237 Graveling, 2018: Ergonomics and Musculoskeletal Disorders (MSDs) in the Workplace. A Forensic and 
Epidemiological Analysis 
238 Da Costa & Viera, 2010: Risk factors for work-related musculoskeletal disorders: a systematic review of recent 
longitudinal studies, here  
239 EU-OSHA, 2020: Work-related musculoskeletal disorders: why are they still so prevalent? Evidence from a 
literature review (p. 15). 
240 EU-OSHA, 2019: Summary - Work-related musculoskeletal disorders: prevalence, costs and demographics in 
the EU (p. 8). 
241 EU-OSHA, 2019: Work-related musculoskeletal disorders: prevalence, costs and demographics in the EU  
242 Ibid., p. 174ff. 

243 Eurofound, 2007: Fourth European Working Conditions Survey (2005) (p. 77). 

244 United Nations Economic Commission for Europe (UNECE), 2015: Handbook on measuring quality of 
employment: A statistical framework, here  

245 Quinlan & Bohle, 2013: Re-invigorating industrial relations as a field of study: Changes at work, substantive 
working conditions and the case of OHS, here (p. 8). 

246 The percentages of responses to this question in the European Working Conditions Survey (EWCS, 2015) are 
displayed. Each bar shows the percentages of the four possible responses for each EU Member State, the 
average for the EU Member States, and the responses for Switzerland and Norway. Responses are displayed for 
the question below: How satisfied are you with working conditions in your main paid job? Answer options were: 
Not at all satisfied; Not very satisfied; Satisfied; Very satisfied. See here 

247 Flash Eurobarometer 398, 2014, p 2, https://www.cesi.org/wp-content/uploads/2014/04/fl_398_sum_en.pdf . 
The displayed Flash Eurobarometer data refer to the ‘working population’, with two subgroups A (employees and 
manual workers), and B (self-employed). In the Flash Eurobarometer sample these two groups are separated 
from three further groups forming the ‘Not working’ population These groups are: subgroups: students, retired, 
looking for a job. 
248 Ibid., p. 58. 
249 Eurofound, 2007: Fourth European Working Conditions Survey (2005) (pp. 77-81). 

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250 Eurofound, 2007: Fourth European Working Conditions Survey (2005) (p. 80). 
251 The ISCED levels 2011 are: ISCED 0: Early childhood education (‘less than primary’ for educational 
attainment); ISCED 1: Primary education; ISCED 2: Lower secondary education; ISCED 3: Upper secondary 
education; ISCED 4: Post-secondary non-tertiary education; ISCED 5: Short-cycle tertiary education; ISCED 6: 
Bachelor’s or equivalent level; ISCED 7: Master’s or equivalent level; ISCED 8: Doctoral or equivalent level. 
252 Eurofound, 2015: Sixth European Working Conditions Survey (EWCS 2015), Data visualisation The exact 
survey question is: ‘Does your work affect your health?’ The percentages in the text are the percentages of the 
response option: ‘Yes, mainly negatively’. Data need to be checked a second time, the EWCS data visualisation 
does not work 
253 Eurofound, 2006: Fifteen Years of Working Conditions in the EU: Charting the Trends (p. 6); EU-OSHA 
calculations based on EWCS raw data. 
254 Average of country values, no weighing according to size of populations per country. EU-OSHA calculations 
based on EWCS raw data. 
255 Eurostat: Persons reporting a work-related health problem by sex, age and educational attainment level, here  
256 Ibid.  

257 Eurostat: Persons reporting a work-related health problem by sex, age and NACE Rev. 2 activity, here 

258 Eurofound mentions the following reasons: ‘In line with the findings from the analysis of the job quality indices, 
multivariate analysis shows that workers are likely to be less optimistic regarding the sustainability of their work if 
they are exposed to any of the following adverse working conditions: work intensity, shift work (particularly daily 
split shifts), night work, fear of losing their job, unfair treatment, and bullying or harassment (Figure 123)’. Sixth 
European Working Conditions Survey – Overview report (2017 Update) (p. 122). 

These same factors also apply equally to the older age cohort (aged 56 or over) who were asked about their 
perceived ability to be doing their current job in five years’ time. EWCS 2015, Overview report (p. 122). 

259 Eurostat: Persons reporting a work-related health problem resulting in time off work by period off, here, Filter: 1 
month or over, and 3 months or over. The question on the period off work is part of a set of questions on work-
related health problems, about the ‘most serious health problem caused or made worse by work’. The question 
about the period of work is exactly: ‘Thinking of the year before [last day of reference week], for how long were 
you off work because of your health problem in this period?’ 
260 Ibid., the value for Finland is from 2013, 2020 data are not provided’ 
261 Ibid., Filter 6 months or over.  
262 Eurostat: Self-reported work-related health problems and risk factors - key statistics, here 
263 Eurofound: European Working Conditions Survey 6 (EWCS 6), 2015, the exact question was: ‘Do you think 
you will be able to do your current job or a similar one until you are 60 years old?’: Eurofound 2017: Sixth 
European Working Conditions Survey – Overview report (2017 Update) (p. 48). 
264 Andersen et al., 2020: Barriers and opportunities for prolonging working life across different occupational 
groups: the SeniorWorkingLife study 
265 Definition: ‘Administrative’ and ‘manual’ work is used throughout the report as a — quite colloquial — 
placeholder to characterise the difference between two major types of work; it is only one of several options. 
International and European institutions developed categories with several levels of aggregation or granularity that 
are applied based on context and the objectives of the analysis. Eurostat uses the European Socio-Economic 
Groups (ESEG) or the International Standard Classification of Occupations (ISCO), EU agencies often use the 
UNESCO International Standard Classification of Education (ISCED) that describes not the occupation but the 
level of skills and education on an aggregated level, and in many international studies and reports the ILO 
International Standard Classification of Occupations (ISCO) is used. 
266 Eurostat: Which sector is the main employer in the EU Member States? Data source: Employment by A*10 
industry breakdowns 
267 The development of questions in the ESENER and EWCS surveys between 2005 and 2015 (EWCS) and 2009 
and 2019 (ESENER) show this development: Questions on industry-related exposures were reduced and 
questions on the impact of work organisation and psychosocial risks extended. 
268 Dixon, 2012: “Emotion”: The History of a Keyword in Crisis 
Dixon writes: ‘The word “emotion” has named a psychological category and a subject for systematic enquiry only 
since the 19th century. Before then, relevant mental states were categorised variously as “appetites,” “passions,” 
“affections,” or “sentiments.” The word “emotion” has existed in English since the 17th century, originating as a 
translation of the French émotion, meaning a physical disturbance.’ 
269 European Parliament, 2019: EU policies – Delivering for citizens: Digital transformation 
270 Cedefop, 2016: The great divide: Digitalisation and digital skill gaps in the EU workforce 

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271 Terminology: Digitalisation refers to enabling or improving processes by leveraging digital technologies and 
digitised data. Digitisation refers to creating a digital representation of physical objects or attributes, for example, 
a scan replaces a paper document. Digital Transformation is business transformation enabled by digitalisation. 
See: What is Digitization, Digitalization, and Digital Transformation? 

272 European Commission Staff Working Document: Accompanying the document Proposal for a Decision of the 
European Parliament and of the Council establishing the 2030 Policy Programme “Path to the Digital Decade” 
{COM(2021) 574 final}, here  
273 Cedefop, 2016: The great divide: Digitalisation and digital skill gaps in the EU workforce 
274 Bernstein & Raman, 2015: The Great Decoupling: An Interview with Erik Brynjolfsson and Andrew McAfee 
275 Eurofound, 2021: The digital age: Implications of automation, digitisation and platforms for work and 

employment 

276 Ibid.  
277 EU-OSHA, 2019: Digitalisation and occupational safety and health (OSH) - An EU-OSHA research programme   
278 EU-OSHA: ESENER Data visualisation 2019 Digital technologies at work.  

279 EU-OSHA: ESENER Data visualisation 2019 Digital technologies at work; Discussion on the impact of such 
technologies on health and safety. 

280 Ibid. 
281 Independent High-Level Expert Group on Artificial Intelligence set up by the European Commission, 2019: 
Ethics Guidelines for Trustworthy AI  
282 EU-OSHA, 2022: Artificial intelligence for worker management: an overview  
283 European Commission: A European Green Deal  
284 Communication from the Commission to the European Parliament, The Council, The European Economic and 
Social Committee and the Committee of the Regions: A new Circular Economy Action Plan: For a cleaner and 
more competitive Europe. 11.03.2020 COM(2020) 98 final, here  
285 EU-OSHA, 2013: Green jobs and occupational safety and health: Foresight on new and emerging risks 
associated with new technologies by 2020 

286 EU-OSHA, 2021: What will the circular economy (CE) mean for occupational safety and health (OSH)? An 
overview of four foresight scenarios. 

287 EU-OSHA, Emerging risks: Workers’ safety and health in green jobs  
288 United States Environmental Protection Agency: Green Engineering  
289 United Nations Environmental Programme (UNEP): Global Chemicals Outlook  
290 CEFIC, Facts and figures: Chemical Industry Contributes $5.7 Trillion to Global GDP and Supports 120 Million 
Jobs, New Report Shows, here 
291 UNEP, 2019: Global Chemicals Outlook II - From Legacies to Innovative Solutions: Implementing the 2030 
Agenda for Sustainable Development (p. 27).  
292 Naidu et al., 2021: Chemical pollution: A growing peril and potential catastrophic risk to humanity 
293 Eurostat: Production and consumption of chemicals by hazard class, here  
294 Statistics Sweden SCB: Environmental accounts – Chemical indicators 2019  
295 EU-OSHA: ESENER Data visualisation 2019 Risk factors present in the establishment – Chemical or 
biological substances. 
296 OSHWiki: Climate change - Impact on Occupational Safety and Health. 
297 Pace advanced from intergenerational conception (children live and work like their parents) to a generational 
conception (children work in a different occupation, compared to their parents but have one main job all their life), 
to intragenerational conceptions (several changes during lifetime), according to: Rosa, 2013: Social acceleration – 
A new theory of modernity. 
298 Eurostat: Employment and activity by sex, age and citizenship (%) - annual data, here 

299 Eurostat: Employment by sex, age and professional status, here, Filter for age class: 15-64 years. 

300 Eurostat: Full-time and part-time employment by sex, age and educational attainment level (1 000), here 
301 European Union | Work | 2019 | Gender Equality Index | European Institute for Gender Equality (europa.eu) 
302 European Institute for Gender Equality (EIGE), 2020: Beijing + 25: the fifth review of the implementation of the 
Beijing Platform for Action in the EU Member States  
303 Eurostat: Employment by sex, age and professional status, here 
304 Ibid.  
305 Eurostat: Skill levels, here  
306 European Commission, 2021: Annual Report on Intra-EU Labour Mobility 2020 (p. 13). 
307 European Commission, 2021: Annual Report on Intra-EU Labour Mobility 2020 (p. 14). 
308 European Commission, 2022: Annual report on intra-EU labour mobility 2021 (p. 108, table ‘Numbers of PD 

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A1 forms issued for postings of workers by EU27 countries, 2011-2020’)  
Eurostat: EU citizens living in another Member State - statistical overview, here 
European Commission, 2019: Towards Fair Labour Mobility: Revision of EU Posting of Workers Rules, 2019  

309 The statistics distinguish between many different categories of migrants, for example, inside EU, from non-EU-
countries, first generation, second generation, seasonal temporary, permanent status, etc. More information here  

310 Ibid. 

311 Fasani & Mazza, 2020: Immigrant Key Workers: Their Contribution to Europe’s COVID-19 Response (p. 8). 
312 Sometimes ‘difficult’ or ‘demeaning’ instead of ‘demanding’. Taken from the Japanese: kitanai, kiken, kitsui  

313 Danaj et al., 2020: Labour Mobility and OSH Vulnerability of Posted Workers: The Cases of Austria and the 
Slovak Republic 

314 European Commission, 2022: Annual report on intra-EU labour mobility 2021 (p. 108, table ‘Numbers of PD A1 
forms issued for postings of workers by EU27 countries, 2011-2020’). 
315 European Parliament, 2017: Posted workers: better protection and fair conditions for all 

316 It is hardly foreseeable how far the experience of interrupted supply chains during the COVID-19 pandemic will 
contribute to a de-globalisation and reduction of international supply chain dependency.  

317 Such methodologies exist for the environmental field, well-known is the ‘ecological footprint’.  

318 Eurofound and the ILO have jointly produced a pilot report on worldwide working conditions to achieve a better 
evidence base for actions and policies, see: Eurofound & ILO, 2019: Working conditions in a global perspective 

319 See: https://www.globalreporting.org/ or UN-PRI (UN Principles of responsible investment) 
https://www.unpri.org/  
320 United Nations, Global Compact, here  
321 European Commission: Corporate sustainability due diligence 

322 Regulation (EU) 2017/821 of the European Parliament and of the Council of 17 May 2017 laying down supply 
chain due diligence obligations for Union importers of tin, tantalum and tungsten, their ores, and gold originating 
from conflict-affected and high-risk areas, here  
323 Centennial Declaration of the International Commission on Occupational Health, ICOH  

324 ILO: Monitoring Compliance with International Labour Standards The key role of the ILO Committee of Experts 
on the Application of Conventions and Recommendations, here  

325 ILO: Conventions and Recommendations 
326 ILO : Convention C-155  
327 ILO : Convention C-187  

328 ILO: Safety and health at work  

329 ILO: Health and Safety at the Workplace  

330 International Social Security Association (ISSA): Vison Zero Overview, Section Companies, here 
331 United Nations, Social Development Goals (SDGs), Goal 8, here and here 
332 WHO: Protecting workers’ health, Key facts  
333 WHO, 2013: WHO Global Plan of Action on Workers’ Health (2008-2017): baseline for implementation: global 
country survey 2008/2009: executive summary and survey findings, here 
334 United Nations, SDGs, Goal 8, here and here 
335 ILO Constitution  
336 ILO: Conventions and Recommendations  
337 Treaty Establishing the European Coal and Steel Community and Annexes I-III, PARIS, 18 APRIL 1951, 
Article 3e 
(DRAFT ENGLISH TEXT), here  
338 Consolidated Version of the Treaty on the Functioning of the European Union Official Journal of the European 
Union, C 326/47, 6.10.2012, Article 151 and Article 153, here 
339 The European Parliament, the Council and the Commission: The European Pillar of Social Rights in 20 
principles, here  
340 EU-OSHA, 2021: Directive 89/391/EEC – OSH “Framework Directive” of 12 June 1989 on the introduction of 
measures to encourage improvements in the safety and health of workers at work - “Framework Directive”, here  
341 Ibid., Framework Directive – Section 2 Employers’ obligations.  
342 Ibid., Framework Directive – Section 3 Workers’ obligations. 

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343 Gagliardi et al., 2012: Occupational safety and health in Europe: lessons from the past, challenges and 
opportunities for the future  
344 Directive 80/1107/EEC, Council Directive of 27 November 1980 on the protection of workers from risks related 
to exposure to chemical, physical and biological agents at work, here 
345 Directive 86/188/EEC, Council Directive of 12 May 1986 in the protection of workers from the risks related to 
exposure to noise at work, here 
346 An overview on these directives can be found here  
347 See for reasons from a trade union point of view: Vogel, 2015: The machinery of occupational safety and 
health policy in the European Union. History, institutions, actors, here 
348 COMMUNICATION FROM THE COMMISSION TO THE EUROPEAN PARLIAMENT, THE COUNCIL, THE 
EUROPEAN ECONOMIC AND SOCIAL COMMITTEE AND THE COMMITTEE OF THE REGIONS: EU strategic 
framework on health and safety at work 2021-2027: Occupational safety and health in a changing world of work, 
{SWD(2021) 148 final} - {SWD(2021) 149 final, Brussels, 28.6.2021, here 
349 European Commission, 2019: Guide to application of the Machinery Directive 2006/42/EC, Edition 2.2 (p. 174).  

350 Regarding other sources: The authors of the DG EMPL Evaluation did not consider the National 
Implementation Reports (due every five years by each Member State on each directive) as relevant for their 
study: ‘In this context, one relevant conclusion is that the attempt to map the findings of the National 
Implementation Reports has yielded no result. The reporting requirements of the National Implementation Reports 
have proven to be formulated too broadly to facilitate quantifications of the replies across MSs or to allow for 
comparability.’  
For this Status Report, SLIC evaluations of the labour inspection systems in Member States were not taken into 
account, because most of them are confidential. 

351 DG Employment, Social Affairs and Inclusion, 2015: Evaluation of the Practical Implementation of the EU 
Occupational Safety and Health (OSH) Directives in EU Member States (p. 89). 

352 Ibid., p. 105. See also p. 89: ‘The Directives represent a mix of a goal-oriented approach – strongly expressed 
in the Framework Directive, but also mirrored in the individual Directives – and a prescriptive approach – which is, 
for instance, seen in the very detailed and specific requirements included in the annexes of some Directives. 

353 Ibid., p. 67. 
354 Ibid., p. 94. 
355 Graveling, 2018: Transposition, implementation and enforcement of EU OSH legislation - Thematic Discussion 
Paper  
356 EU-OSHA, 2021: Summary - Improving compliance with occupational safety and health regulations: an 
overarching review (p. 4).  
357 The authors explain the difference between ‘substantive and rule compliance as follows: ‘... “substantive 
compliance”, which requires compliance with the collective goals underpinning the regulatory scheme (better OSH 
practice); and “rule compliance”, which envisages compliance with the content of legal standards only’ (p. 11). 
358 EU-OSHA, 2021: Improving compliance with occupational safety and health regulations: an overarching review 
(p. 43).  
359 Fundamental Rights Agency (FRA), here, section on Trafficking and labour exploitation  

360 Special Eurobarometer 498: Undeclared Work in the European Union  

361 European Commission, Directorate-General for Employment, Social Affairs and Inclusion et al., 2018: An 
evaluation of the scale of undeclared work in the European Union and its structural determinants : estimates using 
the labour input method, here 

362 ELA: European Platform tackling undeclared work 

363 The OSH Barometer contains a special section on enforcement capacities, here  
364 SLIC, 2015: Common Principles for Labour Inspection in Relation to Health and Safety In the Workplace 
365 Cardiff University et al., 2011: Contract to assess the potential impact of emerging trends and risks on labour 
inspection methodologies in the domain of occupational health and safety,  
European Federation of Public Service Unions (EPSU), 2012: A mapping report on Labour Inspection Services in 
15 European countries (p. 13ff).  

366 The Nordic countries (Denmark, Finland, Iceland, Norway and Sweden) are particularly active in this area. 
They have summarised the current challenges for labour inspections and supervision in general, giving extensive 
and detailed recommendations; Nordic Future of Work Group, 2020: Work today and in the future : Perspectives 
on Occupational Safety and Health challenges and opportunities for the Nordic labour inspectorates, here  
BAuA, 2020: Scientific workshop on the future of smart and effective labour inspection, 3 November 2020, here 

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367 ETUC, 2021: Huge fall in labour inspections raises Covid risk  
ETUC observed in the same period a fall of 0.5 million inspections. Quote: ‘New ETUC research reveals that 
safety inspections have been cut by a fifth since 2010, falling from 2.2 million annual visits to 1.7 million.’ 
368 Eurostat: Annual enterprise statistics by size class for special aggregates of activities (NACE Rev. 2), here 
21.2 million businesses have between 0 and 9 employees. 
369 EPSU, 2012: A mapping report on Labour Inspection Services in 15 European countries (p. 15ff).  
370 ETUC, 2021: Huge fall in labour inspections raises Covid risk  
371 European Agency for Safety and Health at Work, ESENER 2019, Question: Whether establishments have 
been visited by inspectorates in the last three years (% establishments by country ESENER 2019 and 2014, here  
372 SLIC, 2018: Labour inspectors’ guide for assessing the quality of risk assessments and risk management 
measures with regard to prevention of psychosocial risks, No-Binding Publication for EU Labour Inspectors, here  
373 EU-OSHA: E-guide to managing stress and psychosocial risks  
EU-OSHA, 2018: “Healthy workers, thriving companies - a practical guide to wellbeing at work”  
ISO, 2021: ISO 45003 Occupational health and safety management - Psychological health and safety at work - 
Guidelines for managing psychosocial risks, here  
374 European Commission, 2018: Promoting mental health in the workplace. Guidance to implementing a 
comprehensive approach  
375 ILO, 2012: Stress Prevention at Work Checkpoints. Practical improvements for stress prevention in the 
workplace  
ILO, 2021: Violence and harassment in the world of work: A guide on Convention No. 190 and Recommendation 
No. 206  
376 WHO, 2008: PRIMA-EF : guidance on the European framework for psychosocial risk management : a 
resource for employer and worker representatives  
377 OSH Barometer, section Steering of OSH, National strategies, Activities, here  
378 Arbetsmiljöverket, 2015: Organisatorisk och social arbetsmiljö (AFS 2015:4), föreskrifter (Organisational and 
social work environment, Ordinance).  

379 The European Commission (2002) defined stress as the pattern of emotional, cognitive, behavioural and 
physiological reactions to adverse and noxious aspects of work content, work organisation and work environment.  

European Commission, Directorate-General for Employment, Social Affairs and Inclusion, 2000: Guidance on 
work-related stress – Spice of life or kiss of death?  

380 See the OSHWiki article on Psychosocial issues  
381 OSHWiki provides in its articles on ‘OSH System at national level’ for the EU Member States a chapter on the 
‘National strategy’, here  
382 COMMUNICATION FROM THE COMMISSION TO THE EUROPEAN PARLIAMENT, THE COUNCIL, THE 
EUROPEAN ECONOMIC AND SOCIAL COMMITTEE AND THE COMMITTEE OF THE REGIONS: EU strategic 
framework on health and safety at work 2021-2027: Occupational safety and health in a changing world of work, 
{SWD(2021) 148 final} - {SWD(2021) 149 final, Brussels, 28.6.2021, here 
383 OSHWiki: EU OSH Strategic framework  
384 EU-OSHA, 2019: National Strategies in the field of Occupational Safety and Health in the EU  
385 The OSHWiki articles ‘OSH System at national level’ 
(https://oshwiki.eu/wiki/Category:OSH_systems_at_national_level ) contain a chapter on the ‘National Strategy’, 
mostly updated to the newest strategy. in the OSH Barometer see the Section National Strategies 
386 European Agency for Safety and Health at Work, 2019: National Strategies in the field of Occupational Safety 
and Health in the EU, p 9, https://osha.europa.eu/en/file/108414/download?token=2yF1UnxW  
387 The OSH Barometer contains a special section dedicated to National OSH Strategies: 
https://visualisation.osha.europa.eu/osh-barometer/osh-steering/national-strategies 

388 One of the many schemes for the characterisation of national OSH-policies and practical implementation was 
developed in the Nordic Council of Ministers publication: Suikkanen, A., & Kunnari, M. 2008: Principles and 
concepts in Nordic occupational safety and health policies: dimensions of strategic thinking and approaches. 
Nordic Council of Ministers.  
It distinguishes between eight categories of state actions: punitive / supervising / regulative / legislative / 
incentivising / consultative / informative / networking / collaborating / awareness raising / knowledge enhancing 
(from training to research) 

389 European Agency for Safety and Health at Work, 2021: Improving compliance with occupational safety and 
health regulations: an overarching review- Report Executive summary, European Risk Observatory Report, p43 
390 European Commission, DG EMPL: A non–binding guide to best practice with a view to improving the 
application of related directives on protecting health and safety of workers in agriculture, livestock farming, 

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horticulture and forestry, Luxembourg: Publications Office of the European Union, 2012, ISBN 978-92-79-22673-
1, doi:10.2767/53801  
391 European Commission Directorate-General for Internal Market, Industry, Entrepreneurship and SMEs 
Industrial Transformation and Advanced Value Chains, Advanced Engineering and Manufacturing Systems: 
Guide to application of the Machinery Directive 2006/42/EC, Edition 2.2 – October 2019, p174 (Machinery 
directive annex 1, 1.1.6, Official Journal of the European Union, L157/37 
392 EU-OSHA: COVID-19: Back to the workplace - Adapting workplaces and protecting workers, 2020, 
https://osha.europa.eu/en/publications/covid-19-back-workplace-adapting-workplaces-and-protecting-workers  
393 European Commission: Guidelines of the Commission on seasonal workers in the EU Factsheet on practical 
examples and best practices, 2020 
394 European Agency for Safety and Health at Work: E-guide to managing stress and psychosocial risks; 
https://osha.europa.eu/en/tools-and-resources/e-guides/e-guide-managing-stress-and-psychosocial-risks  
European Agency for Safety and Health at Work, 2020: Healthy workers, thriving companies - a practical guide to 
wellbeing at work, 2018. https://osha.europa.eu/en/publications/healthy-workers-thriving-companies-practical-
guide-wellbeing-work  
ISO 2021: ISO 45003 Occupational health and safety management - Psychological health and safety at work - 
Guidelines for managing psychosocial risks. https://www.iso.org/standard/64283.html  
EU Commission, 2018: Promoting mental health in the workplace. Guidance to implementing a comprehensive 
approach. https://ec.europa.eu/social/main.jsp?catId=738&langId=en&pubId=8098&furtherPubs=yes  
ILO – International Labour Organization, Stress Prevention at Work Checkpoints. Practical improvements for 
stress prevention in the workplace, 2012. https://www.ilo.org/global/publications/books/WCMS_168053/lang--
en/index.htm  
ILO – International Labour Organization, 2021: Violence and harassment in the world of work: A guide on 
Convention No. 190 and Recommendation No. 206, 2021. https://www.ilo.org/global/topics/violence-
harassment/resources/WCMS_814507/lang--en/index.htm  
WHO - World Health Organization, PRIMA-EF, 2008: Guidance on the European framework for psychosocial risk 
management : a resource for employer and worker representatives, https://apps.who.int/iris/handle/10665/43966  
Senior Labour Inspectors Committee (SLIC), 2018: Labour inspectors' guide for assessing the quality of risk 
assessments and risk management measures with regard to prevention of psychosocial risks, here  
395 Two EU-OSHA databases present several hundred guidance documents on Dangerous Substances 
https://osha.europa.eu/en/themes/dangerous-substances/practical-tools-dangerous-substances and 
Musculoskeletal Disorders (MSD): https://osha.europa.eu/en/themes/musculoskeletal-disorders/practical-tools-
musculoskeletal-disorders 
396 Examples of such tools and database are: EU-OSHA’s Online Interactive Risk Assessment tool (OIRA) with 
more than 250 tools and more than 180,000 risk assessments https://osha.europa.eu/en/tools-and-resources/oira  
397 See the series of EU-OSHA reports on ‘Safety and health in micro and small enterprises in the EU: 
https://osha.europa.eu/en/themes/safety-and-health-micro-and-small-enterprises 
Descriptions of the good examples are available at: https://osha.europa.eu/en/tools-and-
publications/publications/safety-andhealth-micro-and-small-enterprises-eu-policy-practice/view  
398 European Commission / Senior Labour inspectors committee: Guidance for National Labour Inspectors on 
addressing risks from worker exposure to respirable crystalline silica (RCS) on construction sites, October 2016 
399

Federation) 
SME 
https://www.smeunited.eu/policies/policies/employment/health-safety  ,  EFBWW  European  Federation  of 
Building and Woodworkers (Trade Union), https://efbww.eu/activities/occupational-health-and-safety  
400 OSHWiki: Section ‘OSH System at national level’, descriptions of the social dialogue in each EU Member State 

(Employers 

examples: 

United, 

many 

 Two 

of 

https://oshwiki.eu/wiki/Category:OSH_systems_at_national_level  

401 DG Employment: Website on ‘Social Dialogue’, https://ec.europa.eu/social/main.jsp?catId=329&langId=en  
402

time 

and 

collective 

disputes’, 

see: 

 Eurofound 

‘Database 

of 

wages, 

working 

https://www.eurofound.europa.eu/data/database-of-wages-working-time-and-collective-disputes  
403 E.g.: Prevent (Sweden), DGUV (Germany) AUVA (Austria), see for all EU Member Stress the OSHWiki article 
on ‘OSH-systems at national level’ https://oshwiki.eu/wiki/Category:OSH_systems_at_national_level  
404 European Agency for Safety and Health at Work, 2021: Improving compliance with occupational safety and 
health regulations: an overarching review - Executive summary, https://osha.europa.eu/en/publications/summary-
improving-compliance-occupational-safety-and-health-regulations-overarching  
European Agency for Safety and Health at Work, 2021: Improving compliance with occupational safety and health 
regulations: an overarching review, Literature review; Chapter 3: Societal norms, social reporting, corporate social 
responsibility and support for securing compliance, https://osha.europa.eu/en/publications/literature-review-
improving-compliance-occupational-safety-and-health-regulations-0  
Podgorski, D., 2015: Measuring operational performance of OSH management systems – A demonstration of 
AHP-based selection of leading key performance indicators, in Safety Science, Vol. 73, March 2015, p146-166, 
https://doi.org/10.1016/j.ssci.2014.11.018  

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405 Short descriptions are available on the ISO website, the complete ISO standards are priced. ISO 9001, ISO 
14001 and IISO 31000, n 
406 ISO Committee TC 183: Occupational health and safety management systems 
https://committee.iso.org/home/tc283  
407 ILO, 2009: Guidelines on occupational safety and health management systems (Second Edition)  

https://www.ilo.org/safework/info/standards-and-instruments/WCMS_107727/lang--en/index.htm  

408 Köper B, Möller K, Zwetsloot G., 2009: The Occupational Safety and Health Scorecard – a business case 
example for strategic management, Scand J Work Environ Health 2009;35(6):413-420, doi:10.5271/sjweh.1361  
409 Hutchinson, B., Dekler, S. Rae, A., 2022: Writing plans instead of eliminating risks: How can written safety 

artefacts reduce safety?, 
https://www.sciencedirect.com/science/article/abs/pii/S0925753522000789?via%3Dihub  
410 European Agency for Safety and Health at Work, 2013: Analysis of the determinants of workplace 
occupational safety and health practice in a selection of EU Member States, European Risk Observatory, 
Luxembourg: Publications Office of the European Union,  
doi:10.2802/558  
411 European Agency for Safety and Health at Work: Overview page on ESENER https://osha.europa.eu/en/facts-
and-figures/esener, Data visualisation of ESENER data: https://visualisation.osha.europa.eu/esener/en  
Its third wave, interviewing more than 45,00 establishments across all business, size classes and activity sectors 
in 33 countries, was completed in 2019 and provides comparable results with the 2014 wave. 
412 Schmitt, B., Hammer, A.:2015: Für welche betrieblichen Kontexte ist der Prozess der Gefährdungsbeurteilung 
anschlussfähig? WSI-Mitteilungen, 68(3): 202-211; https://www.wsi.de/de/wsi-mitteilungen-fuer-welche-
betrieblichen-kontexte-ist-der-prozess-der-gefaehrdungsbeurteilung-13201.htm  

413 Beck and Lenhardt, 2019; Lenhardt and Beck, 2016; Baldock et al., 2006: Influences on Small-Firm 
Compliance-Related Behaviour: The Case of Workplace Health and Safety, in: Environment and Planning C: 
Politica and space https://doi.org/10.1068/c0564 ; 

414 Kooperationsstelle Hamburg et. al.. 2010: Contract to analyse and evaluate the impact of the practical 
implementation in the workplace of national measures implementing Directive 98/24/EC on Chemical Agents Final 
Report, Ch. 5 on Risk assessment. The percentage of adequate risk assessments in Member States varies 
between 10% and 50%,  https://ec.europa.eu/social/BlobServlet?docId=10152&langId=en  

415 Lippel, K., Quinlan, M., 2011: Psychosocial hazards in the workplace: Challenges for regulators, Labour 
Inspectors and Worker representatives, Safety Science: Vol. 49, Issue 4, 2011, 
https://www.sciencedirect.com/journal/safety-science/vol/49/issue/4  
416 EU-OSHA: ESENER 2019 What does it tell us about safety and health in Europe’s workplaces? 
https://osha.europa.eu/en/publications/esener-2019-policy-brief  
417 Base: All establishments undertaking lifting or moving people or heavy loads  
418 Base: All establishments undertaking repetitive hand or arm movements  
419 EU-OSHA: Third European Survey of Enterprises on New and Emerging Risks (ESENER 2019): Overview 
Report How European workplaces manage safety and health. Available at: 
https://osha.europa.eu/en/publications/esener-2019-overview-report-how-european-workplaces-manage-safety-
and-health 
420 Sørensen O. H., Hasle P, Bach E., 2007: Working in Small Enterprises: Is There a Special Risk?” Safety 
Science 45, p 1044 – 1059, 10.1016/j.ssci.2006.09.005  
421 Occupational safety and health related research takes a place in all types of scientific disciplines in 
engineering and natural sciences, in medicine, in economic and social sciences and humanities.  
422 Eurostat collects data on an obligatory basis, e.g. the European statistics on work accidents (ESAW) or the 
data from the Labour Force Survey (LFS). Some countries conduct surveys on working conditions with obligatory 
participation (e.g. France).  
423 The Horizon-project INGRID2 provides an overview and offers searchable databases on research sources 

related to working conditions. (https://www.ingridportal.eu/en) : Supporting expertise in inclusive growth, e-
portal ‘Dataset on Working conditions’,  

424 European Agency for Safety and Health at Work: ESENER (European Survey of Enterprises on New and 
Emerging Risks). How European workplaces manage safety and health, 
https://visualisation.osha.europa.eu/esener#!/en  
425 Eurofound, EWCS (European Working conditions survey) 
426 Employment and unemployment (LFS) - Overview: https://ec.europa.eu/eurostat/web/lfs/overview  

427 E.g. Flash Eurobarometer 398: Working conditions, 2014 
https://ec.europa.eu/commfrontoffice/publicopinion/flash/fl_398_en.pdf  

428 https://ec.europa.eu/social/main.jsp?catId=148&intPageId=685  

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429 https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX%3A31994R2062  
430 Communication from the Commission - Adapting to change in work and society: a new Community strategy on 
health and safety at work 2002-2006 /COM/2002/0118 final 
431 European Commission Brussels, 31.5.2013 SWD (2013) 202 final COMMISSION STAFF WORKING 
DOCUMENT Evaluation of the European Strategy 2007-2012 on health and safety at work 
432 Communication from the Commission to the European Parliament, the Council, the European Economic and 
Social Committee and the Committee of the Regions: Improving quality and productivity at work: Community 
strategy 2007-2012 on health and safety at work {SEC(2007) 214} {SEC(2007) 215} {SEC(2007) 216} 
433 Communication from the Commission to the European Parliament, the Council, the European Economic and 
Social Committee and the Committee of the Regions on an EU Strategic Framework on Health and Safety at 
Work 2014-2020, Brussels, 6.6.2014 COM (2014) 332 final 
434 Communication from the Commission to the European Parliament, the Council, the European Economic and 
Social Committee and the Committee of the Regions: EU strategic framework on health and safety at work 2021-
2027: Occupational safety and health in a changing world of work, {SWD(2021) 148 final} - {SWD(2021) 149 final, 
Brussels, 28.6.2021 
435 European Agency for Safety and Health at Work, 2019: National Strategies in the field of Occupational Safety 
and Health in the EU, 2019, https://osha.europa.eu/en/safety-and-health-legislation/osh-strategies 
436 See as overview: https://osha.europa.eu/en/emerging-risks, examples e.g. EU-OSHA, 2014: Current and 
emerging issues in the healthcare sector, including home and community care, European Risk Observatory 
report, European Risk Observatory Report;  
EU-OSHA, 2014: Green jobs, new risks? New and emerging risks to occupational safety and health in the 
electricity sectors, Workshop for European Sectoral Social Dialogue Committee Electricity'; EU OSHA 2019: A 
Review on the Future of Work: Performance Enhancing Drugs  
437 Eurostat: Accident at work statistics 
438 OSH related LFS Ad hoc modules were: 1999 - Accidents at work and occupational diseases; 2007 - Work 
related accidents, health problems and hazardous exposure; 2013 Accidents at work and other work-related 
health problems; 2020 - Accidents at work- and work-related health problems. 
439 Eurofound Website: https://www.eurofound.europa.eu/about-eurofound  
440Eurofound, European Working Conditions Survey 
441 Eurofound, First European Survey on the Work Environment 1991-1992 
https://www.eurofound.europa.eu/sites/default/files/ef_publication/field_ef_document/ef9211en.pdf  
442 European Agency for Safety and Health at Work, ESENER, https://visualisation.osha.europa.eu/esener#!/en  
443 Europeans and Health and Safety at Work, June 1992, https://europa.eu/eurobarometer/surveys/detail/113 ;  
Europeans and Health and Safety at Work, August 1996 https://europa.eu/eurobarometer/surveys/detail/158  
444 Eurobarometer: Working Conditions in Europe, June 1997, https://europa.eu/eurobarometer/surveys/detail/151  
Eurobarometer: Working Conditions, April 2014, https://europa.eu/eurobarometer/surveys/detail/2044  
445 Eurobarometer: Work-Life Balance, October 2018, https://europa.eu/eurobarometer/surveys/detail/2185  
446 Eurobarometer: Undeclared work in the European Union, February 2020 
https://europa.eu/eurobarometer/surveys/detail/2250  
447 The Horizon-project INGRID2 offers links to searchable databases on surveys related to working conditions. 
https://www.ingridportal.eu/en Supporting expertise in inclusive growth, e-portal ‘Dataset on Working conditions’, 
448 e.g.: International Benchmarking on Occupational Safety and Health (OSH) Regulation, revised version 2018, 
http://www.iali-aiit.org/ , 
449 The Horizon-project INGRID2 also provides an overview on these types of databases 
(https://www.ingridportal.eu/en )  
450 European Centre for the Development of Vocational Training CEDEFOP (https://www.cedefop.europa.eu/) 
Skills Panorama: https://skillspanorama.cedefop.europa.eu/en 
451 European Institute for Gender Equality EIGE (https://eige.europa.eu/ ) Gender Statistics Database, Work and 
Labour market, https://eige.europa.eu/gender-statistics/dgs, Gender Equality Index, e.g. index of digitalisation in 
the world of work (2020)  
452 European Chemical Agency ECHA (https://echa.europa.eu/home) Exposure scenario examples  

453 European Centre for Disease Prevention and Control, https://www.ecdc.europa.eu/en  
454 European Maritime Safety Agency EMSA (http://www.emsa.europa.eu/ ), Section on Safety and Security 
http://www.emsa.europa.eu/we-do/safety.html  
455 Fundamental Rights Agency FRA, https://fra.europa.eu/en, Section on ‘Trafficking and labour exploitation, e.g 
the report from June 2021 titled: Protecting migrants in an irregular situation from labour exploitation – Role of the 
Employers Sanctions Directive  
456 European Monitoring Centre for Drugs and Drug Addiction EMCDDA (https://www.emcdda.europa.eu/), 
Section ‘Best practice’, Policy and practice briefings: Work places, https://www.emcdda.europa.eu/best-
practice/briefings/workplace_en  
Quite unknown and difficult to estimate: between one and nine percent of the employees take so-called neuro 

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enhancers. That is medication like tranquilizers, particularly in highly emotional jobs, or stimulants to survive long 
working hours - truck drivers, pilots, doctors etc.. 
457 DG SANTE Health and Food Safety, Area Public Health, (https://ec.europa.eu/health/home_en ), Section on 
EU Action on Health, subsections ‘State of Health in the EU’ (https://ec.europa.eu/health/state/summary_en) and 
‘indicators and Data’ (https://ec.europa.eu/health/indicators_data/overview_en)  
458 Desiere, S., Lenaerts, K, 2020: Integrate and Harmonise National Surveys on Working Conditions? A scoping 
paper, Horizon project: InGRID-2, Integrating Research Infrastructure for European expertise on Inclusive Growth 
from data to policy – project number 730998 https://www.inclusivegrowth.eu/files/Output/D11.5-scoping-paper.pdf  
459 Desiere, S., Lenaerts, K., 2020: Integrate and Harmonise National Surveys on Working Conditions? p16 
460 ILO: National profiles on occupational safety and health National profiles on occupational safety and health  
461 WHO: Global Health Observatory https://www.who.int/data/gho/data/themes/mortality-and-global-health-
estimates  
462 Quote here the new ILO Publication on OSH statistics 
463 Denmark: Ahlmark, N. et al, 2015: Survey nonresponse among ethnic minorities in a national health survey--a 
mixed-method study of participation, barriers, and potentials, in: Ethn Health 2015; 20(6):611-32, doi: 
10.1080/13557858.2014.979768. https://pubmed.ncbi.nlm.nih.gov/25411892/  
Netherlands: Mölenberg, F.J.M., de Vries, C., Burdorf, A. et al. 2021: A framework for exploring non-response 
patterns over time in health surveys. BMC Med Res Methodol 21, 37 (2021). https://doi.org/10.1186/s12874-021-
01221-0  
Aktas, E., Bergbom, B., Godderis, L. et al. Migrant workers occupational health research: an OMEGA-NET 
working group position paper. Int Arch Occup Environ Health (2021). https://doi.org/10.1007/s00420-021-01803-x  
464 ‘European platform tackling undeclared work’, https://www.ela.europa.eu/european-platform-tackling-
undeclared-work  
465 Eurofound: New Forms of Employment, 2020 Update, New Forms of Employment  
466 Fundamental Rights Agency FRA, https://fra.europa.eu/en, Section on ‘Trafficking and labour exploitation 
467 European Labour Authority: https://www.ela.europa.eu/en/home  
468 Besamusca, J., Steinmetz, S.: Vulnerable Groups in European Data Sets, An inventory of the measurement of 
vulnerable groups in 27 data sets covering the European area, Working paper, Horizon project: InGRID-2, 
Integrating Research Infrastructure for European expertise on Inclusive Growth 
https://www.inclusivegrowth.eu/files/Output/D11.3_inventory_report.pdf  
469 European Agency for Safety and Health at Work, 2013: Analysis of the determinants of workplace 
occupational safety and health practice in a selection of EU Member States, Luxembourg: Publications Office of 
the European Union, doi:10.2802/55885 
470 The ‘Directive 89/654/EEC concerning the minimum safety and health requirements for the workplace’ covers 
the following aspects: stability and solidity, electrical installations, emergency routes and exits, fire detection and 
firefighting, ventilation of enclosed workplaces, room temperature, natural and artificial room lighting, floors, walls, 
ceilings and roofs of rooms, windows and skylights, doors and gates, traffic routes - danger areas, specific 
measures for escalators and travelators, loading bays and ramps, room dimensions and air space in rooms - 
freedom of movement at the workstation, rest rooms, pregnant women and nursing mothers, sanitary equipment, 
first aid rooms/equipment, disabled workers, outdoor workplaces (special provisions), Movement of pedestrians 
and vehicles 
471 As example, European Agency for Safety and Health at Work, 2020: Biological agents and prevention of work-
related diseases: a review. Luxembourg: Publications Office of the European Union, 
472 European Agency for Safety and Health at Work: Workers’ exposure survey on cancer risk factors in Europe. 
https://osha.europa.eu/en/facts-and-figures/workers-exposure-survey-cancer-risk-factors-europe  
473 European Agency for Safety and Health at Work, 2021: Foresight Study on the Circular Economy and its 
effects on Occupational Safety and Health; EU-OSHA, 2019: Digitalisation and occupational safety and health - 
An EU-OSHA research programme 
474 DG EMPLOYMENT, SOCIAL AFFAIRS AND INCLUSION: Evaluation of the Practical Implementation of the 
EU Occupational Safety and Health (OSH) Directives in EU Member States, SYNTHESIS REPORT, November 
2015, Available at: https://ec.europa.eu/social/BlobServlet?docId=16897&langId=en ; IALI: International 
Benchmarking on Occupational Safety and Health (OSH) Regulation, revised version 2018, http://www.iali-
aiit.org/ ; OSH-WIKI: OSH Performance Indicators  – and their application in the monitoring and evaluation of 
OSH-infrastructure, OSH-policies and OSH legislation,  
475 European Agency for Safety and Health at Work: ESENER survey; OSHWiki overview: Key performance 
indicators, https://oshwiki.eu/wiki/Key_performance_indicators European Agency for Safety and Health at Work, 
2017: Methodologies to identify work-related diseases: Review of sentinel and alert approaches, Luxembourg: 
Publications Office of the European Union, E European Agency for Safety and Health at Work, 2018: Safety and 
Health in micro and small enterprises in the EU: Final report from the 3-year SESAME project 

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Occupational safety and health in Europe - state and trends 2023 

476 E European Agency for Safety and Health at Work,2013: European Risk Observatory, Analysis of the 
determinants of workplace occupational safety and health practice in a selection of EU Member States, 
https://osha.europa.eu/en/publications/reports/analysis-determinants-workplace-OSH-in-EU  
477 European Agency for Safety and Health at Work, 2019: The value of OSH and the societal costs of work-
related injuries and disease, Luxembourg; 
Elsler D. et al: A review of case studies evaluating economic incentives to promote occupational safety and 
health. Scand J Work Environ Health 2010; 36: 289–298 
478 E European Agency for Safety and Health at Work, 2021: Improving compliance with occupational safety and 
health regulations: an overarching review 
479 Walters D, Johnstone R, Bluff E, Limborg HJ, Gensby U.: Improving compliance with occupational safety and 
health regulations: an overarching review EU-OSHA, 2021. Improving compliance with occupational safety and 
health regulations  
480 ILO and integration of OSH Into decent work https://www.ilo.org/global/topics/dw4sd/themes/osh/lang--
en/index.htm 
481 Dijk, F., Yohama Caraballo-Arias, Y.: Where to Find Evidence-Based Information on Occupational Safety and 
Health? https://www.annalsofglobalhealth.org/articles/10.5334/aogh.3131/ 
Trade union position, one example: Vogel L (2014), The point of view of the European trade unions: It is urgent to 
revitalise the EU occupational health and safety policy, http://www.osha.mddsz.gov.si/.../Laurent_VOGEL_EN.pdf 
Employer position, one example: Safer and healthier work for all  - Modernisation of the EU occupational safety 
and health legislation and policy, 
482 Eurofound; Labour market change New forms of employment: 2020 update 
483 Eurofound, 2020: Working conditions in sectors, Publications Office of the European Union, Luxembourg, 
doi:10.2806/024695, p. 41 
484 Norway, STAMI: https://noa.stami.no/ National monitoring of work environment (National overvåkning af 
arbeidmiljø) 
485 Detailed Action Plan for the 4 Main Strategies to Create Safe Workplaces (update from 2020) 
https://kosha.or.kr/english/publications/Resources.do?mode=view&articleNo=277001&article.offset=0&articleLi
mit=10  
486 Sakurai, H.: Occupational Safety and Health in Japan: Current Situations and the Future 
https://www.jstage.jst.go.jp/article/indhealth/50/4/50_MS1375/_pdf/-char/ja  
487 Occupational Safety and Health Administration Ministry of Labor, Republic of China (Taiwan): National 
Occupational Safety and Health Profile of Taiwan, 2014, Chapter 8 National Occupational Safety and Health 
Profile of Taiwan  
488 See: https://www.mom.gov.sg/workplace-safety-and-health/wsh-reports-and-statistics  

489 E.g.: National Academies of Sciences, Engineering, and Medicine. 2018. A Smarter National Surveillance 
System for Occupational Safety and Health in the 21st Century. Washington, DC: The National Academies 
Press. https://doi.org/10.17226/24835, 2018  

490 E.g.: Publications from the Association of Workers' Compensation Boards of Canada, https://awcbc.org/en/ 
491 Australian Safety and Compensation Council, Report on indicators for occupational disease, Australian 
Government, 2006, p1-45 
492 E.g.: https://data.worksafe.govt.nz/  

493 International Labour Organisation ILO (no publishing date available). Decent work: Measuring decent work. 
http://www.ilo.org/integration/themes/mdw/lang--en/index.htm  

494 Country profiles on Occupational Safety and Health, https://www.ilo.org/safework/countries/lang--
en/index.htm  
495 Work Health Organisation WHO (2011). Global Health Observatory: WHO indicator registry., from: 
http://www.who.int/gho/indicator_registry/en/index.html 
496 United Nations: Sustainable Development Goals, https://sustainingdevelopment.com/sdg8-indicators/  
497 UNECE, 2010: Measuring Quality of Employment, https://unece.org/statistics/publications/measuring-quality-
employment  

498https://ec.europa.eu/eurostat/web/labour-market/quality-of-employment/database 

499 Eurostat overview on their data related to quality of employment https://ec.europa.eu/eurostat/web/labour-
market/quality-of-employment 

500 Andersen, J. H., et al., 2019: Systematic literature review on the effects of occupational safety and health 
(OSH) interventions at the workplace. Scandinavian Journal of Work Environment and Health, 45(2): 103-113 

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Occupational safety and health in Europe - state and trends 2023 

501 European Agency for Safety and Health at Work, 2019: The value of occupational safety and health and the 
societal costs of work-related injuries and diseases, Publications Office of the European Union, Luxembourg, 
doi:10.2802/251128 
502 A hint in this direction gives the EWCS 1995 evaluating per occupation the responses to the question: ‘Is your 
job more difficult because of a chronic or permanent health problem by occupation?”. Between 72% and 81% of 
the manually dominated occupations (agriculture, crafts, machine operators, elementary occupations) respond: 
‘No, never’, that is, between 19% and 28% of these occupations see such problems. Compared to this, between 
86% and 90% of the high-level clerk workers respond: ‘No, never’, that is, comparatively less, only between 10% 
and 14% see these problems. 

503 WHO: Cultural context of health and well-being, Policy brief No 1, Culture matters: using a cultural contexts of 
health approach to enhance policy-making, Cultural context of health and well-being 

. 

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The European Agency for Safety and Health 
at  Work  (EU-OSHA)  contributes  to  making 
Europe  a  safer,  healthier  and  more  productive 
place to work. The Agency researches, develops 
and distributes reliable, balanced and impartial 
safety and health information and organises pan-
European awareness-raising campaigns. Set up by 
the European Union in 1994 and based in Bilbao, 
Spain, the Agency brings together representatives 
from the European Commission, Member State 
governments  and  employers’  and  workers’ 
organisations, as well as leading experts in each 
of the EU Member States and beyond. 

European Agency for Safety and Health at Work 
(EU-OSHA)

Santiago de Compostela 12, 5th floor
48003 Bilbao
Spain
Tel: (+34) 944 358 400
Email: information@osha.europa.eu

https://osha.europa.eu