Zero Harm is an Occupational Disease

I’ll never forget Fred. He never knew, but he has been one of the people who helped to shape my thinking during my first years as a safety professional. With his lean and not even 1,70 m (~ 5’ 6”) short frame he didn’t have an impressive physical appearance, but his personality and commitment sure made up for it. He worked as a carpenter in the department that did the interior refurbishments of passenger trains at the Haarlem workshop. More importantly for me, he was a member of the emergency response and first aid team (which was one of the responsibilities of the workshop’s safety advisor) and a very active occupational safety and health representative of his department and driving member of the Occupational Safety and Health Committee.

The Arbowet (the Dutch equivalent of the Safety and Health at Work Act) points out that good OH&S management is shaped through cooperation of employer and employees. For this goal the representatives met with the workshop’s management on a regular basis. Fred, however, often used to have this typical ‘old fashioned’ union stance that employers hardly ever had the best of intentions with the workforce. I suspect that this was one way for him to stay critical – something he did very well. In the end, however, there may have been some truth to his stance. One day he had to call in sick and after an absence of some weeks he came to my office and brought me the news he had feared all along: he had been diagnosed with mesothelioma. Within one year he died.

For many, many years crocidolite, the so-called ‘blue asbestos’, had been used to isolate coaches of passenger trains, among others, for soundproofing and shock absorbing. Long before I started as a safety advisor at the workshop, Dutch Railways had started removing this highly hazardous material from their trains, but as a carpenter, Fred had been exposed to high levels of the invisible fibers during the 1960s and 1970s when there was a serious lack of awareness, let alone adequate protection. Fred spent his last year battling the disease and responsible parties. Obviously he lost the former, worn out by chemo treatment and cancer, but he at least had the pleasure to see success in the latter since he was one of the people who initiated a good compensation scheme for victims of asbestos exposure.

These days many companies have fabulous Occupational Health and Safety Policies. Growing awareness and modern legislation have come a long way. No self-respecting business wants to do damage to man or environment and so many of them have safety goals and follow up their safety metrics. Nobody wants to have fatalities, and so the ‘Zero FAT’ hasn’t only become a sales slogan for healthier food, but also a safety parameter that many a company boasts with. Of course most companies don’t stop at measuring FAT. No, most strive for zero lost time injuries (LTI) as well. Some departments of the company I work these days, for example, regularly celebrate when there has been a certain period of Zero LTIs. But how useful is this measurement, really?

Deep Water Horizon and Texas City have underlined what many of us knew before: LTIs are no parameter one should use when managing process safety. But isn’t it a good parameter for occupational safety then? Hardly. I won’t go into any of the common and highly valid reasons (like being reactive and highly dependent on what’s reported) why FAT, LTI and the like are weak safety metrics at best, and misguiding most of the time. This time I’d like to focus a bit on another drawback: there is quite a lot they don’t cover!

The Ashgate newsletter recently alerted me to a new book, “Safety Can’t Be Measured”, subtitled “An Evidence-based Approach to Improving Risk Reduction” by Andrew S. Townsend. I haven’t had the chance to read the book yet, but the description on the publisher’s website sounds highly interesting, and the first chapter (freely downloadable from said site) bodes well.

In this first chapter, Townsend places occupational health and safety in a larger context by looking back at human mortality since the dawn of time. One interesting observation is that only since the 1920s has life expectancy been back on the level it had been some 10,000 years earlier! More relevant for us safety professionals, however, is the finding that accidental death in the workplace is insignificant when compared to the total of accidental deaths: car accidents and falls at home humble even the worst work-related fatality statistics. Even more interesting: deaths attributable to occupational health issues are estimated to be higher than accidental deaths in the workplace by a factor of 25! Oddly, these aren’t found in corporate safety stats or targets of pithy slogans.

Also, Fred never made it into the safety statistics, except maybe in hindsight on a national level. Yet his untimely and way too early death had a clear and direct causal relation to the safety and health at the workplace since mesothelioma is very specific for exposure to crocidolite. None of the commonly used safety metrics, however, covers these cases. In my time at the workshop I never had a FAT (yet one or two close calls), but every year we had to bury one or even several (former) colleagues who succumbed to asbestos-related diseases. Isn’t it ironic that if someone trips in the office, strains his ankle and has to stay at home for a day we’ll find him/her as a part of the LTI-index, but if someone dies 30 years after work exposure to asbestos there’s no mention in any of the statistics?

This is only scratching the surface of what isn’t captured by most traditional accident/injury oriented safety metrics. There are many factors related to occupational health that may cause cancer (and eventually be fatal) like some kinds of saw dust, ceramic fibers, radiation, polycyclic aromatic hydrocarbons and other chemical substances. But there is much more that may cause permanent damage to humans without actually killing them. Take for example the number one problem for many of the slightly older colleagues in my company: work related loss of hearing, due to exposure to noise over long periods of time. I doubt that any of those ever had a lost work day because of this, but their full hearing ability will never return.

Other examples of factors that over time will lead to occupational disease may include physical strain (be it a ‘mouse arm’ or a worn out back), solvents (affecting the neural system) or work-related stress (‘burn out’ probably the fastest growing occupational disease in the Western world). There are, of course, other factors that we don’t even have a full grasp of potential consequences of, like genetically modified substances and nanotechnology.

So, what would be a way forward then?

First of all, we should do what has been said by several others many times before: don’t stop looking back at what happened, counting injuries and incidents, but also, and especially, start looking forward. Find proactive metrics and measure most of all what your company does to create safety and health in the workplace. Use reactive data most of all as the proverbial ‘litmus test’ and as an opportunity for further learning and improvement.

Secondly, find metrics that cover the full spectrum of HSE(Q) and not only safety in the narrowest sense. Suggestions for widening the spectrum are mentioned above, but there are many more. Nobody knows the workplace better than your employees, so ask them. And do mind that there are factors that may escape our usual safety and health thinking, especially social issues like mobbing, substance abuse, gambling or isolation at work camps or rigs.

A keyword in finding better metrics is having a focus on the hazards and the risk these hazards pose. Then we can look what to do about them and what can happen if they fulfill their potential. But that might be something for another article. For now I need you to help prevent traditional safety metrics and ‘Zero Harm’ goals becoming the Safety Professional’s Number One Occupational Disease in that they blind us to some very important aspects of our job!


Carsten Busch photoCarsten Busch works as Section Head Safety and Quality for the infrastructure division of the Norwegian Rail Administration. Carsten has studied Mechanical Engineering and after that Safety. He also spent some time at Law School. He has over 20 years of HSEQ experience from various railway and oil & gas related companies in The Netherlands, United Kingdom and Norway. For more on Carsten, please visit his blog.


  1. Alan D. Quilley says:

    Carsten – Another fabulous thought provoking article! Cary – Thanks for sharing!

  2. Paul says:

    What an incredible story and sad at the same time. Safety should be taken serious and the number one priority at all time. Thanks for the great read.

    1. Carsten says:

      Paul, thanks for the kind words. As I just wrote in my reply to Crystal – safety is about balance, but some things are non negotiable.

  3. Cary Usrey says:


    Thank you for sharing. I never really thought about it until reading your article. These types of workplace injuries/illnesses can easily be overlooked since they often occur much later than the exposure(s).

    It reminded me of the question – If a tree fell in the woods and nobody was around to hear it, would it make a sound?

    If nobody remembers the exposure(s), then no sound is made relative to safety metrics.

    1. Carsten says:

      Thanks Cary,

      I’ve been slightly frustrated about the all too common (so-called) safety metrics in use. When I thought about occupational hazards, like noise and chemicals, it struck me once more how incredibly insufficient the commonly used metrics are. Not only are these build on some severe logical flaws, but also do they neglect truly fundamental parts of OH&S. Which does severe injustice to the workforce, and ourselves!

  4. Crystal says:

    Carsten-Thank you again for your excellent article. As I look back on my father who worked with “Asbestos/Silica Materials”, before there was a concern in wearing PPE and his final loss to lung CA. It is a great reminder that we can never let our guard down on constantly trying to improve the health all workers. Thanks again!

    1. Carsten says:

      Crystal, thanks for those kind words! My experiences with asbestos and several colleagues lost to the long-time consequences (which were caused some 20 or 30 years before I even knew them!) truly helped me to take some issues bloody serious and not to compromise on certain aspects. Even though safety management is all about compromise and balance, some bottomlines will not be crossed!

  5. Roderick van Gelder says:

    Great article, thank you for the insight.
    I believe the big problem with LTI’s, MTI’s, Zero Harm, etc. is that it still separates the safety aspect from the job. Until safety becomes an integrated part of the work we will be exposed to these reactive measuring sticks.
    40 years ago when seatbelts were introduced in cars there were all sorts of arguments from people who couldn’t possibly do their job if they had to wear a seatbelt in their car. Today “buckle up” is a standard part of driving a car, that’s where occupational health & safety should be too.

  6. Mark Brunker says:


    Thanks for a heartfelt and clear article.

    In Australia, as I am sure elsewhere in the world, safety KPI’s are regularly being requested in work tenders, potentially inclining companies to find ever more granularity in safety reporting to avoid losing business opportunities. We can, through good intention (such as finding safe contractors for work) create an environment which drives down perception of safety reality. The acute and immediate takes centre stage when the chronic can be, as your article clearly shows, far more devastating.

    The difficulty is not showing why current metrics are problematic, but in devising ones which are not. Broadly applicable metrics (LTI etc) are interpreted and reported differently, skewing their intent. Metrics which are workplace specific, are unlikely to be helpful in tender, regulatory or audit processes.

    I believe we need to accept that there will always be a need for the problematic metric (LTI etc) for external reporting. There is little we can do about it, because flawed as they are, there is not a lot of alternative. Using them as a comparative tool between companies is not always as clear an indicator as we would like it to be. Using them as a year on year trend monitoring tool is better, but as you point out in reference to Deepwater horizon etc, even that is not without issue.

    Internally however we must be better than that. The first question, asked in the broadest possible sense is – ‘have we caused, or could we cause harm?’. If the answer is yes, and it always will be, the question which follows is ‘how do we eliminate or mitigate the harm?’. What follows is an action plan, to be resourced, enacted and measured – Did we do what we said we would do, and did it work? Have we applied our resources to best effect in protectin the health and safety of our workers? Then ‘have we caused, or could we cause harm?’…

  7. Richard N Knowles says:

    These observations about the metrics are good. We also need to understand that safety is a complex adaptive system and that establishing cause and effect is not possible in most cases since there are many causes and deciding which one is usually quite arbitrary. Richard N. Knowles, The Safety Sage

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