Prevention of Heart Attacks and Other Cardiovascular Diseases

Prevention of heart
attacks and other

cardiovascular diseases
A guide for managers, employees and
company health professionals
Health
2013
The global oil and gas industry association for environmental and social issues
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International Association of Oil & Gas Producers

London office
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OGP Report Number 491

OGP/IPIECA 2013 All rights reserved.
No part of this publication may be reproduced, stored in a retrieval system, or transmitted in

any form or by any means, electronic, mechanical, photocopying, recording or otherwise,
without the prior consent of IPIECA.
Prevention of heart
attacks and other
cardiovascular diseases
A guide for managers, employees and
company health professionals
All photographs reproduced courtesy of Shutterstock.com, except pages 8, 26, 27 and 30 which are
courtesy of iStockphoto.com, and page 12 which is courtesy of Bibiphoto/Shutterstock.com.
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PREVENTION OF HEART ATTACKS AND OTHER CARDIOVASCULAR DISEASES
Contents
Executive summary
Alcohol
23
Introduction
Lack of sleep
24
What is a heart attack?
Sleep disorders
24
Symptoms of a heart attack
How sleep affects you heart
24
The brain and strokes
Practical behavioural changes
24
What can the oil and gas industry do?
25
Hypertension (abnormally high

blood pressure)
Stress
26
What is blood pressure?
What is stress?
26
Normal blood pressure
How stress affects the heart
27
Interpreting the BP readings
Warning signs of stress
27
When to treat hypertension
Employees role in stress reduction
27
Non-medical treatment
28
Medical treatment
Smoking
10
The ageing workforce and

cardiovascular risk
29
Smoking and cardiovascular disease
10
Characteristics of the older workforce
29
Smoking and respiratory disease
11
Smoking and cancer
11
30
Other adverse health effects
11
What oil and gas companies can do to

address the risk of cardiovascular disease
Smoking in the workplace
11
Why should companies address the issue?
30
What can companies do?
30
Metabolic disorders
13
Cholesterol and triglycerides
13
Conclusion
31
Elevated blood sugar levels
14
References
32
16
Glossary
36
Physical inactivity
17
Health impacts of physical inactivity
17
How much physical activity do we need?
18
Risks and benefits of physical activity
18
Obesity
19
Psychosocial origins of the epidemic
19
Obesity and the oil and gas workforce
20
20
Nutrition and diet
21
Nutrition and cardiovascular disease

practical behavioural changes
21
22
ii
Appendices
Appendix 1Workplace health promotion
(or cardiovascular prevention) checklist
38
Appendix 2H-Factor Programme

(Sample of an information leaflet on prevention
programmes aimed at employees within eni-Saipem)
40
Appendix 3Healthy workplaces: a model

for actionFor employers, workers, policy-makers
and practitioners
(a World Health Organization guide)
43
Executive summary
Overview
Heart attacks and strokes related to
cardiovascular disease (CVD) are the main causes
of death among people working in the oil and
gas industry today. This reflects a trend in the
wider global population: worldwide, 13 million
people died of heart attacks and strokes in 2011,
and CVD-related deaths per head of population
are increasing.
Although primarily non-occupational, and often
a consequence of lifestyle choices, cardiovascular
diseases represent a significant challenge to the
current and future operational and financial
performance of the oil and gas industry.
Designed primarily for company medical
professionals and line managers, this document
provides basic guidance on the main types of
CVDs and their causes and symptoms.
The report also looks at some implications of
cardiovascular diseases for the oil and gas
industry, and offers strategies and improvements
that can be implemented to help reduce the
number of CVD-related deaths in future.
A reference section indicates additional sources
of information relating to CVD. The appendices
include three useful tools that can help to
reduce the incidence of workforce CVDs by
raising awareness of their risks, causes,
symptoms and outcomes, and also to promote
healthier lifestyles, both at work and at home.
Raising understanding and awareness of

heart attacks and strokes, and the main
causes of cardiovascular disease.
The main body of this report provides an
introduction to heart attacks and strokes,
including their symptoms and potential industry
responses. It also offers a guide to the most
common causes of cardiovascular disease while
suggesting optionsboth non-medical and
medicalfor reducing the risks.
The main causes of CVD include:

hypertension (abnormally high blood
pressure);
smoking and the use of smokeless tobacco;
metabolic disorders;
physical inactivity;
obesity;
nutrition and diet;
alcohol;
sleep disorders;
stress; and
ageing.
Oil and gas industry responses to the risk

of cardiovascular disease
Global trends suggest that the oil and gas
industrys future workforce may be more
susceptible to lifestyle choices that can increase
the incidence of CVD. For this reason it is
essential for companies to put in place riskbased health promotion programmes that are
capable of addressing this lifestyle problem.
Without such efforts, the future repercussions
are likely to have a negative impact on the
industrys business.
This report urges the industry to implement
initiatives to promote workforce well-being and
to sustain them over the long term. It is essential
to understand that the risk of CVD is a global
problem that is likely to worsen both worldwide
and in the oil and gas sector. Data on the issue
should be collected over time and used to
coordinate mitigation efforts and provide
feedback to management.
Specific and general recommendations to
address CVD are contained throughout the
report. It suggests that effective company
leadership has a key role in promoting workforce
well-being and reducing CVD risk factors.
Among actions recommended by the report are
the implementation of health assessments and
screening; awareness, education and training;
promotion of risk factor reduction, such as
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smoking prevention and reduction, healthier

diets, increased physical activity, stress
prevention and reduction, and fatigue
management.
One suggestion in this regard is that the industry
should consider involving the families of its
workers in the reduction of CVD risk through the
provision of initiatives, such as family fitness
days, promoting healthy diets and lifestyles.
Conclusion
Awareness and prevention of cardiovascular
diseases, although a non-occupational problem,
can have a positive impact on business. For this
reason it is imperative that the industry develops
and sustains health management programmes
that address this issue.
The work location is often the first place where

cardiovascular risk factors are identified and
where steps can be implemented to provide
treatment or prevention. However, it must be
clearly understood that the onus of prevention
and treatment rests with individual employees
and not the company or industry.
The oil and gas industry is unique because work
often takes place at remote locations where
medical care may be limited and that are long
distances from specialist treatment centres. For
this reason, regular health assessments can help
identify and reduce risk factors, and define
individual action plans to promote healthy
lifestyles, improve the quality of life and reduce
medical bills. Healthy individuals have a greater
chance of living longer.
Introduction
Cardiovascular diseases (CVDs), i.e. heart attacks
and strokes, are the main causes of death within
the oil and gas industry.
Within the general population, it is estimated
that more than 13 million deaths occur
worldwide as a result of ischaemic heart disease,
stroke or other form of cerebrovascular disease;
this is more than 10 times the number of yearly
deaths caused by road vehicle accidents.
Heart attacks and strokes, considered as nonoccupational illnesses, are mainly due to the
coexistence of numerous cardiovascular risk
factors due to lifestyle issues which, along with
ageing, increase the death toll.
The more cardiovascular risk factors one
accumulates over the years, the greater the risk
of having a heart attack or stroke at an early age
with increased potential severity. The major
cardiovascular risk factors include:
high blood pressure;
tobacco use;
high levels of cholesterol in the blood;
high levels of sugar in the blood;
physical inactivity;
overweight or obesity;
poor nutrition (an unhealthy diet); and
alcohol use;
and to a lesser degree:
lack of sleep; and
poor stress management.
Other cardiovascular diseases (peripheral arterial
diseasealso known as peripheral vascular
disease; rheumatic heart disease; congenital
heart disease; deep vein thrombosis; and
pulmonary embolism), although potentially
severe, are responsible for far fewer deaths per
year in the world.
cardiac risk factors are identified and where steps
can be taken to provide treatment or remedy.
However, it must be clearly understood that the
Figure 1 The human heart

aorta
pulmonary artery
superior vena cava
right coronary artery

left coronary artery
inferior vena cava
left ventricle
right ventricle
onus of prevention and treatment rests on the

individual and not on the company or industry.
This basic guidance document is designed for
doctors, medical professionals, employees and
line managers, and outlines a number of
strategies and improvements that the oil and gas
industry can implement to reduce the number of
CVD-related deaths in the years to come.
What is a heart attack?

A heart attack (also called a myocardial
infarction, coronary thrombosis or coronary
occlusion) is a condition caused by the complete
blockage of one or more of the coronary arteries
or its branches, i.e. the blood vessels that supply
blood and oxygen to the heart muscle.
Above: the heart is a

muscle that pumps
blood to the organs
of the body. Located
in the thorax,
between the two
lungs, the heart
beats approximately
70 times a minute or
more than 100,000
times per day, every
day throughout life!
In one day the heart
will have pumped
more than 30,000
litres of blood. The
heart rate increases
during exercise, fear
and excitement.
This condition commonly occurs in men over 40

years old and to a lesser degree in women over
50 years of age after the menopause. Heart
attacks can also occur in men in their 20s and
30s with a family history of premature coronary
artery disease.
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Figure 2 Causes of a heart attack
1. Atherosclerosisthe artery is clogged

with fatty substances, e.g. cholesterol
2. Blood clotprone to developing in

arteries affected by atherosclerosis
spreads to the neck, back, jaw, shoulders or

arms (particularly the left arm and hand);
lasts for more than 15 minutes, sometimes
coming and going;
occurs at rest or during activity;
is often accompanied by palpitations,
fainting, cold sweats, nausea or vomiting,
shortness of breath, and a feeling of fear,
anxiety, imminent death or impending doom;
and
may be accompanied by signs of shock or
loss of consciousness.
3. Spasma temporary constriction

in the artery wall
Above: a heart attack

occurs when the
blood vessels that
supply the heart
become blocked. This
can result from a
narrowing of the
arteries due to fatty
deposits, which in
turn can encourage
the formation of
blood clotsthe
most common cause
of a heat attack. A
less common cause is
a spasm, i.e. a
sudden, temporary
tightening of the
muscles in the walls
of artery.
With the worldwide increase in female

consumption of tobacco, women are rapidly
catching up with men in terms of heart attack
frequency and age of occurrence.
Ageing and the cardiovascular risk factors can
lead to a narrowing and hardening of the
arteries in the body. This is called arteriosclerosis.
In the coronary arteries, which irrigate the heart,
this results in reduced blood flow to the cardiac
muscle. If a build-up of fatty deposits
(atherosclerosis), a blood clot or spasm totally
clogs or constricts one of the previously
narrowed arteries the result is a heart attack. If
the blood flow is not restored quickly, the heart
muscle becomes damaged from lack of oxygen
and begins to die. This is an emergency.
Symptoms of a heart attack

The typical symptom of a heart attack is chest pain,
which:
is most often severe, persistent, and described
as tightness, squeezing or a crushing
sensation usually located in the centre of the
chest behind the breastbone or sternum; it
may mimic heartburn in some cases;
4
Women are less likely to survive heart attacks

than men!
Women are just as vulnerable to heart attacks as
men, and represent nearly half of the heart attack
deaths worldwide. To put this in perspective,
women have a much greater chance of dying of a
heart attack than of dying from breast cancer.
Because the menopause is a cardiovascular risk
factor, women tend to experience heart attacks
about 10 years later than men.
Heart disease has often been mistakenly
considered to be a mans disease. And because
heart attack symptoms in women are often very
different to those experienced by men, women
are less likely to realize, or even to believe, that
they are having a heart attack. It is common for
women to fail to recognize the symptoms of a
heart attack and, as a consequence, women are
more likely to delay emergency treatment.
The most common heart attack symptom for
women, as in men, is pain or discomfort in the
chest. However, more than 40% of women report
having no chest pain or discomfort prior to, or
during, their heart attack. This absence of chest
pain can result in lost time and incorrect diagnosis
on the part of the receiving medical professional.
Major symptoms in women during a heart attack
often include one or more of the following
these may also be responsible for additional lost
time and incorrect diagnosis:
unusual fatigue
sleep disturbance
sleep disturbance
shortness of breath;
indigestion
anxiety
cold sweats
dizziness
A suspected heart attack is a medical

emergency requiring urgent attention.
Treatment is most effective when administered
within the first hour (the golden hour) after
the onset of symptoms. The faster a person
having a heart attack is transferred to
emergency facilities where the clogged arteries
can be unclogged, the greater his or her
chances of surviving.
Unfortunately, almost one-third of all heart
attacks are silent and go completely
unrecognized. They do not produce symptoms
of chest pain, and the victim may be treated for
a non-cardiological problem. For example, chest
discomfort may be confused with indigestion or
anxiety. In such cases, patients have a greater
risk of dying than those who experience the
typical severe chest pain of a heart attack.
Any chest pain which lasts for more than 15
minutes must be considered a heart attack, and
the victim should be transported to a medical
facility as a matter of urgency.
The brain and strokes
Figure 3 The human brain
common are haemorrhagic strokes which occur

when a weakened blood vessel ruptures, causing
bleeding into the brain.
Strokes affect men more often than women.
Ageing (most strokes appear over 65 years of age
but they can appear at any age) and the same
cardiovascular risk factors that produce a heart
attack are responsible for ischaemic strokes.
What is a stroke?
A stroke is the clogging or bleeding of an artery
in the brain provoking the partial or total
destruction of one or more of the specialized
nerve centres. This medical emergency can result
in neurological damage (e.g. partial or total
paralysis of a limb or an entire side of the body
(hemiplegia), speech impairment (aphasia), vision
or memory loss, etc., coma, disability and death.
Irreversible damage appears when the brain tissue
is deprived of oxygen for more than three hours.
Ischaemic strokes, i.e. those caused by a blood
clot which cuts off the flow of blood to the brain
(also called brain attack or acute ischaemic
cerebrovascular syndrome) are responsible for
more than 80% of all strokes observed. Less
Symptoms of a stroke
The brain is a highly

developed computer
made up of billions of
nerve cells or neurons
with various specialized
nerve centres that
coordinate and
regulate everything in
the bodyfrom the
memory, reasoning
and emotions to the
heart beat, breathing
and body temperature
as well as the mobility
and sensitivity of the
body. Blood is carried
to the brain by the
carotid and vertebral
arteries which branch
out into a complex
arterial network within
the brain.
Early recognition and treatment of a stroke is

essential in order to reduce the severity and
increase the chances of total recuperation.
The US National Stroke Association has identified
the Act FAST rule for rapid recognition of a
stroke:
F for Face: Ask the person to smile. Does one
side of the face droop?
A for Arms: Ask the person to raise both arms.
Does one arm drift downward?
S for Speech: Ask the person to repeat a simple
phrase. Is their speech slurred or strange?
T for Time: If any of the above signs appear
contact the local emergency service immediately.
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Figure 4 Causes of a stroke
blood clot
cerebral artery
Above: an ischaemic
stroke occurs when a
blood clot lodges in
an artery causing a
blockage, which in
turn cuts off the flow
of blood to the brain.
Less common are
haemorrhagic
strokes (not shown on
the diagram) which
occur when a blood
vessel ruptures,
causing bleeding
into the brain.
Smoking, alcohol,
obesity and stress,
among other factors,
are important
contributors to heart
attacks and strokes.
Cardiovascular risk factors

The major cardiovascular risk factors are
summarized in the Introduction on page 1.
Whilst steps can be taken to reduce the risk of
CVD from these factors, there are several other
cardiovascular risk factors which cannot be
changed. These include:
Age: the older one gets the greater the risk.

More than half of all heart attacks and
ischaemic strokes take place after the age
of 65.
Gender: men are more likely to develop
cardiovascular problems than premenopausal
women (however, once past the menopause,
a womans risk is similar to that of a man).
Heredity: if there is a history of heart attacks
in a family, particularly under the age of 55,
the likelihood of having a heart attack
increases.
The good news is that it is possible to reduce

the effects of the majority of cardiovascular risk
factors by modifying certain poor lifestyle
habits. However, it is important to realize that
all of the cardiovascular risk factors are
intertwined, for example: smoking increases
blood pressure; stress and smoking increase
levels of bad cholesterol; and lack of sleep
increases obesity and blood pressure.
The following sections review each of the
cardiovascular risk factors and identify what the
individual and company can do to reduce the
risks.
Hypertension (abnormally high blood pressure)

Blood pressure
should be measured
with a properly-sized
and calibrated
instrument, with the
subject in a seated or
lying position, after a
five-minute rest and
with the arm resting
level with the heart.
Hypertension is a major and highly prevalent

aetiological factor in the development of
cardiovascular disease as well as heart and
renal failure. It is estimated that around 1,000
million people worldwide suffer from
hypertension; this number will continue to rise
over the coming years due to increased life
expectancy and the other cardiovascular risk
factors reviewed in this document.
Hypertension alone is estimated to cause 4.5%
of the disease burden globally, which is more
than that caused by tobacco or alcohol.
What is blood pressure?

Blood pressure is the pressure exerted by the
blood on the walls of the arteries. It is described
using two numbers, such as 120/80. The top
number is the systolic pressure, which
corresponds to the pressure in the arteries when
the heart contracts. The bottom number is the
diastolic pressure, which corresponds to the
blood pressure in the arteries when the heart
rests between heartbeats.
A stethoscope and inflatable cuff-like
manometer (sphygmomanometer) placed
around the arm are all that is required to
measure blood pressure. Blood pressure
readings should be taken on both arms and can
be expressed either in millimetres or centimetres
of mercury (Hg).
testedcuffs that are too small or too large will

produce erroneous results). The test should be
carried out with the patient in a seated or lying
position, after a minimum five-minute rest and
with the arm to be measured resting level with
the heart. It is also advisable for the
measurement to be taken two or three times, for
example at the beginning, during and at the end
of the consultation. It is possible for an
individual to carry out a self-measurement if
properly trained. This may benefit patients by
allowing them to monitor their blood pressure
response to antihypertensive medication,
thereby improving patient adherence to therapy.
Normal blood pressure

Having ones blood pressure checked is a simple,
painless medical activity that only takes a few
minutes, but which can save lives by preventing
a heart attack or stroke years later. If high blood
pressure is diagnosed and confirmed, treatment
is required.
Blood pressure should be measured with a
properly calibrated instrument which has an
adequately-sized cuff (i.e. the width of the cuff
should be 40% of the circumference of the limb
The accepted threshold for normal blood

pressure varies constantly over an individuals
lifetime, and even during each 24-hour cycle.
Normal blood pressure for an adult (age 18 and
above) is considered to be 120/80 mm Hg.
Variations of this value can be considered in
respect of an individuals age (e.g. the elderly),
sex and possible coexisting morbidities (e.g.
type 1 diabetes, coronary artery disease, chronic
kidney disease).
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It is natural for blood pressure to vary during the

day, from one day to the next, and in reaction to
stressful situations, depending on a variety of
factors. Repeated measurements of blood
pressure are therefore recommended before
establishing the diagnosis. One elevated blood
pressure reading does not mean that a person has
high blood pressure; however, such a reading
should be followed by additional measurements
over a period of several weeks. The physician may
wish to monitor an individuals blood pressure at
home via a 24-hour monitoring device. This
process is called ambulatory blood pressure
monitoring (ABPM) and records blood pressure
values during the wide range of situations and
activities that a person experiences throughout
the day, including during sleeping periods. The
averages of the 24-hour values that are used to
diagnose hypertension are a systolic
measurement above 129 mm Hg, or diastolic
measurement above 80 mm Hg.
Interpreting the BP readings
Normal blood
pressure is considered
to be below
120/80 mm Hg, as
shown on this digital
blood pressure meter.
Normal blood pressure is considered to be

<120 mm Hg for systolic and <80 mm Hg for
diastolic blood pressure.
Prehypertension (a US classification for cases
where an individuals BP is higher than normal
but not high enough to be considered
hypertension) is defined as a systolic blood
pressure between 120139 mm Hg or a
diastolic pressure between 8089 mm Hg.
Stage 1 hypertension is defined as a systolic

blood pressure between 140159 mm Hg or a
diastolic pressure between 9099 mm Hg.
Stage 2 hypertension is defined as a systolic
blood pressure 160 mm Hg or a diastolic
pressure 100 mm Hg.
When to treat hypertension?

Accurate hypertension diagnosis is key to
efficient control.
The majority of high blood pressure diagnoses
fall into the category of primary hypertension
(also known as essential or idiopathic
hypertension). Primary hypertension has no
identifiable cause and is asymptomatic until
complications develop. It is estimated that 30%
of individuals with hypertension are unaware
that they have the condition. Symptoms and
signs are unspecific and arise from
complications in organs which may sustain
damage due to uncontrolled hypertension
(referred to as target organs).
To diagnose hypertension at least two blood
pressure determinations should be made over a
period of three days. For borderline cases the
measurements should be repeated before
diagnosing an individual as hypertensive. The
ABPM process can also be helpful in some cases
to document or exclude the diagnosis of
hypertension.
Blood pressures greater than 140/90 mm Hg on
repeat examination should be considered for
further evaluation and therapy, with the
exception of the elderly (e.g. aged 70 years or
more) where 150/90 mm Hg is considered to be
the upper limit.
When considering a diagnosis of hypertension,
appropriate blood tests and investigations for
target organ damage should be carried out, as
well as a formal assessment of cardiovascular risk.
The goal of hypertensive therapy is the

reduction of cardiovascular and renal morbidity
and mortality by lowering the blood pressure.
An untreated hypertensive patient is at great
risk, not only of developing a disabling or lethal
CVD (e.g. left ventricular failure, myocardial
infarction, stroke) but also of renal failure and
retinal affections of the eyes. Effective medical
control of hypertension will prevent or forestall
all complications and prolong life in patients
with elevated numbers such as a diastolic blood
pressure greater than 90 mm Hg.
Medical treatment
In clinical trials, antihypertensive therapy has
been associated with average reductions of
3540% in stroke incidences; 1525% in
incidences of myocardial infarction; and more
than 50% in incidences of heart failure.
Non-medical treatment
Non-medical treatment mainly addresses
lifestyle modifications and the management of
coexisting conditions (e.g. diabetes, cholesterol).
Lifestyle modifications may contribute to
preventing and reducing hypertension at all
stages of the condition; however, these
modifications are not always enough to
normalize BP even though they may reduce it
by up to 1015 mm Hg.
Lifestyle modifications that can reduce blood
pressure and prevent hypertension include:
reducing weight in individuals who are
overweight or obese;
implementing dietary measures to reduce salt
intake (to less than 5 g/day), and control
diabetes and blood lipids (fats);
increasing physical activity;
moderating alcohol consumption; and
cessation of smoking.
When an individual is not able to normalize

blood pressure through lifestyle modifications
alone, certain blood pressure-reducing
medication may be required. This will need to be
prescribed by a physician. The goal of such
medication is to bring the individuals elevated
blood pressure down to acceptable levels.
Non-medical
treatment, such as a
healthy diet to help
lose weight, reduce
salt intake and
control diabetes,
may contribute to
reducing blood
pressure by up to
1015 mm Hg.
Antihypertensive medications should be taken

by those people who have:
Stage 1 hypertension, or a 24-hour ABPM
average of 130/80 and above, plus any of
the following:
target organ damage;
established cardiovascular disease;
renal disease; or
a 10-year cardiovascular disease risk of 20%
or more.
Stage 2 hypertension.
Successful medical treatment of blood pressure
requires regular medical monitoring and
follow-up.
It should be clearly understood that
hypertension is a chronic condition which, in the
majority of cases, requires lifelong treatment.
It is also important to be aware that any
termination of medication will result in a
reappearance of the cardiovascular risk.
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Smoking
The term smoking refers to the use of cigarette,
pipe, cigar and shisha tobacco.
Many people revert to smokeless tobacco, such
as chewing tobacco, spit tobacco, chaw and
snuff, thinking that these are safer because they
dont involve smoking. False! Smokeless tobacco
is highly addictive, delivers twice the nicotine
dose of one cigarette, and causes numerous
health problems.
The US Centers for Disease Control (CDC)
reports that adverse health effects from
tobacco use account for an estimated 443,000
deaths, or nearly one in every five deaths, each
year in the USA.
According to the World Health Organization
(WHO), tobacco kills nearly 6 million people each
year, of whom more than 5 million are users and
ex-users, and more than 600,000 are nonsmokers exposed to second-hand smoke.
More deaths are caused each year by tobacco
use than by all deaths from human
immunodeficiency virus (HIV), illegal drug use,
alcohol use, motor vehicle injuries, suicides and
murders combined. Smoking causes an
estimated 90% of all lung cancer deaths in men,
80% of all lung cancer deaths in women, and is
the cause of an estimated 90% of all deaths from
chronic obstructive lung disease.
Smoking and cardiovascular disease

Smoking is widespread. It increases the risk of
coronary heart disease and can lead to the
development of peripheral vascular disease
resulting in reduced blood circulation.
Cigarette smoking damages the lining of
arteries, leading to a build-up of fatty material
(atheroma) thereby reducing the space for blood
to pass through. The carbon monoxide in
cigarette smoke reduces the amount of oxygen
10
that the blood can carry to the heart and body.

Nicotine in cigarettes stimulates the body to
produce adrenaline, which increases the heart
rate and raises blood pressure, resulting in the
heart having to work harder. This increases the
tendency for blood to clot.
Smoking decreases exercise tolerance and leads
to a decrease in high density lipoprotein (HDL),
i.e. the good cholesterol. It also increases the
risk of abdominal aortic aneurysm. Studies have
shown that cigarette smoking is an important
risk factor for stroke; inhaling cigarette smoke
produces several effects that can damage the
cerebrovascular system. Women who smoke and
use oral contraceptives are at increased risk of
both coronary heart disease and stroke.
When combined with a family history of heart
disease, cigarette smoking also seems to greatly
increase the risk of cardiovascular disease.
Passive smoking, where non-smokers breathe in
second-hand smoke from people around them,
is also harmful. Research has shown that nonsmokers who live with smokers have a greater
risk of coronary heart disease than those who
do not.
Smoking and respiratory disease
Smoking has been linked to a number of

respiratory diseases, including:
chronic obstructive pulmonary (lung) disease
(COPD)a group of diseases including
chronic bronchitis and emphysema;
lung cancer and other cancers of the oral
cavity, esophagus and larynx; and
asthma.
sudden infant death syndrome (SIDS); and

predisposition of smokers children to
respiratory illnesses (e.g. asthmas, more
frequent colds, etc.).
Dental problems are very common for users of

smokeless tobacco, and include gum and tooth
decay, discoloured teeth, loss of teeth, and bad
breath as well as a decreased sense of taste and
smell. Smokeless tobacco users are also at
higher risk for heart disease and high blood
pressure.
Smoking and cancer

Smoking is known to cause the following
cancers:
bladder cancer;
acute myeloid leukaemia;
cancer of the cervix;
cancer of the oesophagus;
kidney cancer;
cancer of the larynx (voice box);
lung cancer;
cancer of the oral cavity (mouth);
cancer of the pharynx (throat);
stomach cancer; and
cancer of the uterus.
Smoking in the workplace
Although smokeless tobacco does not produce

respiratory problems or lung cancer because
there is no smoke inhalation, its use had led to
an increased incidence of cancers of the throat,
tongue and mouth. Oral cancer is a particularly
deadly form of cancer, killing 30% to 50% of
newly diagnosed individuals within five years.
Benefits for employees include:

reduced exposure to cigarette smoke and, as
a consequence, a reduction in the incidence
of smoking-related diseases;
saving money;
motivation of smokers to stop smoking; and
reduced risk of work-related fires.
Other adverse health effects
Smoking can have adverse affects on

reproduction, pregnancy and small children. It
increases the risk of:
infertility;
preterm delivery;
stillbirth;
low birth weight;
Employers can improve the health of their

employees by creating a smoke-free workplace
and promoting smoking cessation initiatives.
Smoking in the workplace will commonly target
cigarettes, pipes, cigars and shishas.
Many state and local governments now require
workplaces to be smoke-free and/or designated
areas to be set aside for use as smoking areas.
Benefits of a smoke-free workplace
Benefits for the employer include:

promotion of a healthier and safer work
environment;
reduced downtime due to smoking breaks;
reduced absenteeism;
reduce medical expenses; and
reduced office maintenance costs (cleaning,
carpets, furniture, etc.).
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IPIECA OGP
Smoke-free workplace programme

Steps to creating a smoke-free workplace
include:
Developing a policy and a plan: company
management and human resources officials
should work to define a no-smoking policy
and the manner in which it will be
implemented across the workplace.
Employees and management should work
together to define a successful smoke-free
work place programme, and identify areas
that can be designated and clearly marked as
smoking areas. The company should create
awareness and information programmes to
inform staff and employees about the
dangers of smoking, and promote cessation
programmes (e.g. patches, consultations, etc.).
Creating a supportive environment:
for example, avoiding discrimination against
smokers, and making sure that the emphasis
is on encouraging smokers to engage with
their health rather than penalizing them for
being tobacco users.
Initial studies suggest that electronic
cigarettes do not have negative effects on the
cardiovascular system but do affect lung
functions. Further study will be necessary
before firm conclusions can be drawn about
the safety of electronic cigarettes, and this is
an important reason why any policy for
smoking in closed spaces/offices should apply
to electronic cigarettes as well as real
cigarettes.
12
Metabolic disorders
Cholesterol and triglycerides
Cholesterol and triglycerides are two types of lipid
(or fatty substance) found in all parts of the body,
including the bloodstream. They are essential to
human life but, in excess, can be harmful.
Cholesterol is produced by the liver and is also
consumed in the foods that we eat. It is a
structural component of cell membranes and is
used in the production of hormones, vitamins
and bile acids. The main sources of dietary
cholesterol are meat, poultry, fish, eggs and
dairy products. Certain meats are especially high
in cholesterol content, while foods of plant
origin contain no cholesterol.
Triglycerides are the main form of fat in the
body. Their main purpose is to supply the bodys
energy needs. Consumption of meats, other
fatty foods, and foods that are high in sugars or
starch can increase the levels of triglycerides in
the blood.
Types of cholesterol
Cholesterol and triglycerides are transported
around the body within soluble carriers known
as lipoproteins. There are different types of
lipoproteins, each classified by density; the lower
the density of the lipoprotein the greater the
amount of fats contained within it. This
characteristic is used to identify the different
types of cholesterol in the blood:
LDL cholesterol (low density lipoprotein) is
the bad cholesterolelevated levels are
associated with an increased risk of coronary
heart disease, stroke and peripheral arterial
disease.
HDL cholesterol (high density lipoprotein) is
the good cholesterolits presence prevents
atherosclerosis by extracting the bad
cholesterol from the artery walls.
Total blood cholesterol is the sum of LDL and
HDL cholesterol, and also includes a
percentage of triglycerideselevated levels
of triglycerides are associated with certain
diseases including cardiovascular diseases.
Table 1 The cardiovascular risks associated with different levels of cholesterol and triglycerides in the blood
(internationally accepted normal levels are indicated in bold)
Types of
cholesterol / lipid
Levels of cholesterol and

triglycerides in the blood
Associated
cardiovascular risk
Total cholesterol
<200 mg/dl (<5.2 mmol/l)
Reduced risk of CVD
200239 mg/dl (5.26.2 mmol/l)
Borderline high value
240 mg/dl (6.3 mmol/l) and above
CVD risk multiplied by 2
<100 mg/dl (2.6 mmol/l)
Reduced risk of CVD
100159 mg/dl (2.594.11mmol/l)
Borderline high value
160-190 mg/dl (4.14 mmol/l) and above
Increased CVD risk
LDL cholesterol
HDL cholesterol
>38 mg/dl (>1 mmol/l)

60 mg/dl (1.55 mmol/l) and above
Considered as protective of CVD
3859 mg/dl (0.981.53 mmol/l)
The higher the HDL level, the lower

the CVD risk
< 38 mg/dl (<0.98 mmol/l)
Increased CVD risk
Ratio LDL/HDL
<3.5
Triglyceride
<100 mg/dl (<2.6 mmol/l)

<150 mg/dl (1.69 mmol/l)
Normal
150199 mg/dl (1.692.25 mmol/l)
Borderline high
200500 mg/dl (2.265.65 mmol/l) and above
Increased CVD risk
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IPIECA OGP
Associated cardiovascular risks

Table 1 shows the degree of cardiovascular risk
associated with various concentrations of
cholesterol and triglycerides in the blood. The
internationally accepted norms for cholesterol
and triglyceride levels are indicated in bold text.
Note that increased blood levels of LDL
cholesterol and reduced blood levels of HDL
cholesterol are strongly associated with
cardiovascular disease.
Factors influencing cholesterol and

triglyceride levels
Numerous factors are responsible for increasing
the levels of cholesterol and triglyceride in the
blood, such as diet, obesity, sedentary lifestyle
and smoking.
Several medical conditions, including diabetes,
hypothyroidism (decreased thyroid function),
liver disease, and chronic renal (kidney) failure
can also increase cholesterol levels. Some
medication, especially steroids, can also increase
cholesterol levels.
Diets rich in cholesterol and saturated fats
increase LDL levels. This bad cholesterol is
responsible for the creation of fatty deposits in
blood vessels. Over time these deposits narrow
and obstruct the arteries (atherosclerosissee
image below).
Measures that can be proposed to reduce

elevated cholesterol and triglyceride levels
include:
educating the workforce;
promoting healthy foods (fruits, vegetables,
fish) and reduced portion size;
ensuring that the workforce is aware and
informed of the food sources and risks of
elevated cholesterol and triglyceride levels;
providing a visible and appetizing, low-fat
healthy food option, and reducing the
amount of trans fats in workplace menus;
educating the workforce concerning the risks
of alcohol and sugar in elevating triglyceride
levels; and
encouraging the workforce to identify their
individual risk factors through screening and,
where necessary, to seek medical care for
treatment.

Glucose and its function
Glucose is a sugar that is vital to human health.
When glucose is metabolized in the body it
provides energy to the cells. The muscles and
brain must have a supply of glucose as a source
of energy to function.
Diabetes
Diabetes mellitus, or simply diabetes, is a chronic
metabolic condition where the level of blood
glucose (blood sugar) has become too high. This
occurs when the body does not produce enough
insulin (which helps cells to absorb the glucose
from the blood), or when the body cannot
effectively use the insulin it produces.
Diabetes is characterized by fasting blood sugar
levels of 125 mg/dl (7.0 mmol/l) or higher and,
over time, can lead to serious damage to
several of the bodys organs, especially the
blood vessels and the nerves.
14
In some people, the level of blood glucose may

be higher than normal but not yet high enough
to indicate diabetesin this case the condition
is known as pre-diabetes.
According to World Health Organization, there
are currently 347 million people living with
diabetes worldwide. The number is estimated to
rise to more than 460 million by 2030.
Types of diabetes
There are two main types of diabetes:
Type 1 diabetes: previously known as insulindependent diabetes, this develops when the
bodys immune system mistakenly destroys
the insulin-producing cells in the pancreas. As
a result, the body is unable to produce insulin.
Type 1 diabetes is usually diagnosed in
children and young adults.
Type 2 diabetes: previously known as noninsulin dependent diabetes, this occurs when
the body does not produce enough insulin, or
when the body becomes unable to use the
insulin it produces (insulin resistance). It is the
most common form of diabetes, representing
90% of diabetes cases worldwide, and can
develop at any age. It is often associated with
obesity, lack of physical activities and poor diet.
Diabetes may also occur during pregnancy,
when some women produce higher than normal
levels of glucose in the blood. When diabetes is
diagnosed during pregnancy it is referred to as
gestational diabetes.
Pre-diabetic state
Pre-diabetic individuals are those people with a
fasting blood glucose level between 100 mg/dl
(5.55 mmol/l) and 125 mg/dl (6.94 mmol/L) and
are at significant risk of developing type 2
diabetes within the next 10 years.
globally and within the oil and gas industry, and

which is mainly lifestyle dependent.
Signs and symptoms of diabetes

A large number of people with elevated blood
sugar levels have no symptoms. When symptoms
occur, the following are common:
increased thirst;
frequent urination;
excessive hunger;
weight change;
increased fatigue;
changes in vision;
tingling or numbness in the hands or feet; and
recurring skin or other infections.
Managing elevated blood glucose levels
Type 2 diabetics can initially be managed with

a combination of diet and increased physical
activity, followed by medication if necessary
(oral medication or insulin injection).
Careful medical management through weight
loss and lifestyle improvement may not only
reduce the need for medication but, in some
cases, may also retard the progression of the
disease and normalize blood sugar levels.
The same factors can prevent a pre-diabetic
condition from evolving to full blown diabetes.
The management of metabolic syndrome may
be necessary; this occurs when a range of
metabolic risk factors occur together in an
individual causing increased risk of heart
disease, stroke and diabetes. The set of risk
factors for metabolic syndrome includes:
Left: a diabetic
patient measuring
glucose levels in the
blood using a blood
glucose meter
The following text deals exclusively with type 2

diabetes, the most common form encountered
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IPIECA OGP
HDL (good) cholesterol of less than

40 mg/dl (1.04 mmol/l) in men or less than
50 mg/dl (1.30 mmol/l) in women;
a triglyceride level of 150 mg/dl
(1.69 mmol/l) or greater;
high blood sugar levels with fasting blood
glucose of 100 mg/dl (5.55 mmol/l) or greater;
insulin resistance or glucose intolerance
due to improper functioning of insulin; and
abdominal obesity (i.e. excess body fat
around the waist).
Complications of diabetes
Long-term complications may include:
cardiovascular disease (heart attack, heart
failure, stroke, etc.);
chronic kidney failure;
eye damage leading to blindness (e.g.
cataract, retinopathy, glaucoma);
nerve damage;
vascular disease of the limbs (i.e. leading to
gangrene and amputation);
erectile dysfunction in men; and
increased rate of infections.
Near right: diabetes

can lead to a range
of complications in
addition to
cardiovascular
disease, including
for example eye
damge due to
cataracts,
retinopathy and
glaucoma.
Far right: providing
access to gym
facilities is just one
of a number of ways
in which the
industry can help its
employees reduce
the risks from
metabolic disorders.
16

The following approaches are recommended to
provide awareness of the risks from metabolic
disorders and to help individuals avoid them:
Create and sponsor company wellness and
healthy lifestyle programmes.
Increase risk-based health promotion and
health education.
Encourage health awareness, e.g. via a
diabetes awareness day or reduce obesity day.
Promote healthy eating in companycontrolled catering facilities, e.g. through the
provision of free dietary consultations.
Promote physical activity by setting up onsite exercise facilities (in locations with large
numbers of employees) or subsidizing gym
membership, encouraging walking, jogging
and cycling.
Provide free periodic medical checks for all
employees and their spouses.
Physical inactivity
Studies have shown
that individuals who
do not remain
physically active,
either through daily
activities or
scheduled exercising,
are at greater risk of
cardiovascular
disease.
Individuals who do not undertake the minimum

recommended amount of daily physical exercise
required to maintain good health are said to be
physically inactive.
General day-to-day physical activity includes
walking, climbing stairs or cycling, occupational
(i.e. at work) and household activities, and
games. Physical activity may also include
scheduled sports or aerobic activity and/or
muscle-strengthening exercises that are usually
designed specifically to improve and/or maintain
physical fitness.
Health impacts of physical inactivity

Studies have demonstrated that physical
inactivity, also referred to as a sedentary lifestyle,
is associated with a number of illnesses including
cardiovascular diseases. The WHO indicates that
physical inactivity has been identified as the
fourth leading risk factor for global mortality,
and may account for an estimated 3.2 million
deaths globally. Physical inactivity is also
estimated to be the main cause of approximately
30% of heart attacks worldwide.
The health benefits of regular physical activity are

strongly supported by epidemiological studies:
regular physical activity is highly beneficial in
preventing CVDs (and in reducing the severity of
symptoms with individuals already suffering from
a CVD), whether people maintain an active daily
lifestyle and/or participate in scheduled physical
activity. Research shows that as much as half of
the functional decline between the ages of 30
and 70 is due not to ageing itself but to an
inactive way of life.
The direct and/or indirect benefits of regular
physical activity in reducing CVD risk factors are
summarized below:
Improved blood flow to the heart muscle.
Reduced blood pressure: regular exercising
mainly aerobic activitycan help to reduce
systolic (and, to a lesser extent, diastolic)

blood pressure by up 10 to 15 mm Hg. This is
achievable over a period of several months.
Reduced blood fat levels: regular exercising
can decrease triglycerides and increase HDL
(good) cholesterol. A decrease in total and
LDL (bad) cholesterol is reported only when
weight loss and/or a reduction in dietary fats
are associated with regular physical activity.
Improved body mass index (BMI), and healthy
changes in body composition towards more
lean muscle and less fat: regular physical
activityespecially when combined with a
lower calory dietcan contribute to losing
weight and reducing body fat.
Improved blood sugar levels and decreased
insulin requirements.
Reduced inflammatory biomarkers: regular
physical activity has a chronic antiinflammatory effect, triggering a reduction in
C-reactive protein (CRP) and other
inflammatory markers.
In addition to reducing CVD risk factors, the

practice of a regular physical activity has a number
of other positive effects such as reducing the risk of
breast and colon cancer, improving control ofor
even preventingnon-insulin dependent diabetes
mellitus. It also contributes to maintaining a
healthier musculoskeletal system, including
prevention of osteoporosis. Last but not least,
exercising reduces stress, and improves energy
levels, sleep and well-being, lowering the risk of
developing anxiety or depression.
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How much physical activity do we

need?
Health agencies are actively promoting a
physically active lifestyle and have set a minimum
recommended amount of physical activity:
A baseline average of 20 to 30 min of physical
activity every day in addition to the physical
activity performed as part of the job function
and/or routine duties at home (for example
cooking or doing the laundry, walking to the
car park, or shopping).
Walking is probably the safest and easiest
activity that can be performed by everyone,
and this could be optimized by simple
practices such as parking the car away from
the office and/or taking the stairs instead of
the elevators. Also consider the following tips:
If you elect to engage in physical activities,
choose a practice you enjoy and set goals.
This could involve playing golf, or
swimming, etc.
Get into a routinego to the pool or gym,
join a fitness class, or plan a regular run:
this will ensure that you get some
scheduled exercise.
Keep movingwhenever you can, walk,
cycle or run instead of taking the car.
Limit the time you spend watching TV or
sitting in front of a computer during leisure
time.
Spread your sessions of moderate to
vigorous aerobic activity throughout the
week. Do at least 10 minutes of physical
activity at a time.
Join a team or exercise with another
persontake part in sports and recreation
activities in groups.
A greater amount of physical activity beyond
the above baseline recommendations will
provide even greater health benefits.
Employers have a leading role to play in
promoting an active lifestyle. Creating a gym
within the office facilities or subsidizing
membership in health clubs, sponsoring walking
18
and/or cycling events, and/or providing

pedometers are good examples of simple but
very effective initiatives. Leaders have a role in
supporting workplace activity, demonstrating
healthy behaviour and encouraging others to
make time for physical activity.
Risks and benefits of physical activity

Epidemiological studies clearly demonstrate the
benefits of sustained physical activity over time.
It is recommended that all individuals planning
to embark on any form of exercise programme
consult with a health-care professional before
doing so.
Obesity
Obesity is a global epidemic that presents
significant health risks to virtually all age groups
in both developed and developing countries. It
also poses particular challenges for the healthcare community when assessing the suitability
of workers for different occupational roles.
Epidemiological evidence suggests that levels of
obesity will continue to increase worldwide
unless a concerted global effort is undertaken to
address this ongoing problem.
Most people can check to see whether their
weight is healthy by using a measure known as
the body mass index (BMI). A persons BMI is
calculated by dividing their weight (in kilograms)
by their height (in metres) squared. For example,
an adult who weighs 70 kg and is 1.75 m tall will
have a BMI of: 70 (1.75 x 1.75) = 22.9 kg/m2
Obesity is generally indicated by a BMI above 30 (a
BMI of 25 indicates overweight). Current estimates
by the WHO indicate that almost one in 10 of the
worlds adult population is obese. In the oil and
gas industry, a conservative estimate is that more
than one-third of the workforce is overweight or
obese, and this is considered to be increasing.
There are several indicators for obesity, including
BMI and the measurement of the waist
circumference. The latter is the thought to be the
best indicator of cardiovascular risk, because BMI
is subject to variations in interpretation in
different populations and in varying individual
circumstances. For example, scientific evidence
shows that Asians tend to develop CVDs and
diabetes at lower BMIs than European people,
and bodybuilders and pregnant women have a
clear justification for the additional weight
relative to their height.
categories should be tailored to accommodate

those who are overweight or obese.
Psychosocial origins of the epidemic

Below are some examples of changes which,
over the years, have driven a cultural shift
towards obesity:
The development of modern transportation
and urbanization.
Mass marketing and the availability of cheap,
abundant, high-calorie foods (i.e. fast food).
The non-sustenance role of food.
An increase in sedentary lifestyle and the
24-hour availability of food.
Overweight or obese people have a greater
frequency of suffering:
heart attacks;
strokes;
diabetes;
sleep apnoea;
osteoarthrosis of the hips and knees; and
greater predisposition to some diseases (e.g.
certain cancers).
Obesity has become

an issue of epidemic
proportions around
the globe, and
presents a
considerable health
and safety risk.
Although obesity can pose certain health and

safety risks it is imperative that such individuals
are not discriminated against in the work
environment. It is essential that oil and gas
companies put in place weight loss programmes
to address this issue, and where possible, work
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Figure 5 Estimated obesity (BMI 30 kg/m2) prevalence (%), in males aged 15 and over (2010 data)
Prevalence (%)
< 1.3
1.3 < 5.3
5.3 < 9.0
9.0 < 14.4
14.4 < 20.5
20.5
not available
Source: adapted from Ono, T.,

Guthold, R., Strong, K. WHO Global
Comparable Estimates, 2005. The
boundaries and names shown and the
designations used on this map do not
imply the expression of any opinion
whatsoever on the part of the World
Health Organization concerning the
legal status of any country, territory,
city or area or of its authorities, or
concerning the delimitation of its
frontiers or boundaries. Dotted lines
on maps represent approximate
border lines for which there may not
yet be full agreement. WHO 2012.
All rights reserved.
In addition, overweight and obese individuals

are often considered to be predisposed to:
increased absenteeism;
increased medical expenditures; and
decreased life expectancy.
Obesity and the oil and gas workforce

Challenges specific to the oil and gas workforce
include the following:
Many oil and gas operations take place in
remote locations (e.g. on offshore platforms)
which may be situated at a considerable
distance from the nearest specialist treatment
centre; the provision of medical assistance to
address problems related to obesity (as well
as other health problems) may therefore be
particularly challenging.
Obesity can be considered a safety risk and
may influence fitness for duty in certain
circumstances (e.g. offshore vessels, confined
or narrow stairs, fire brigade rescue
operations, evacuation by lifeboat and
helicopter, etc.).
20

Where possible, companies should:
identify overweight and obese employees;
raise awareness about the effects of overweight/
obesity, and the less well-known waist-toheight ratio as well as BMI as a measure of risk.
inform about, and promote, a healthy diet;
require catering staff to provide healthy foods
that are identified as such (i.e. low in calories,
fat, sugar, salt, etc.), and encourage healthy
food habits (e.g. reducing calories, using well
prepared and tasty vegetables and desserts)
and a reduction in portion size;
require catering companies to remove
artificial trans fats;
encourage company walks, and distribute
pedometers;
encourage the use of gyms, fitness clubs and
safe areas at work locations;
reassign severely obese employees when
safety issues have been identified with regard
to their weight; and
provide leadership to demonstrate support
for healthy eating and fitness.
Nutrition and diet

Fuelled by urbanization and the growth of the
global economy, many developed and
developing nations are foregoing their
traditional patterns of eating in favour of a
Western diet typically high in animal products
and refined carbohydrates, and low in whole
grains, fruits and vegetables.
An unhealthy diet can have a direct impact on
many conditions that increase the risk of CVD,
including blood cholesterol levels, body weight,
blood pressure and blood glucose levels.
Adopting a healthy diet together with a healthy
lifestyle can reduce the risk of heart disease,
heart attacks and strokes, and can help to avoid
conditions that may eventually lead to heart
disease.
Nutrition and cardiovascular

diseasepractical behavioural
changes
The following guidelines for healthy food and
nutrition can help to reduce or even eliminate
some cardiovascular risk factors.
Reduce salt intake

The amount of dietary salt consumed by an
individual has a direct impact on blood pressure
and cardiovascular risk. The WHO recommends a
salt intake of less than five grams (about one
teaspoon) per person per day. Adding salt to
food and eating foods containing high salt
levels, particularly processed foods, frequently
contribute to exceeding the recommended
intake of salt.
Reduce consumption of fats

It is important to limit saturated fats and trans
fats such as beef, pork, lamb, bacon, high-fat
dairy products, butter and most processed foods.
Preference should be given to monounsaturated

and polyunsaturated fats found in olive oil,
canola (rapeseed) oil, nuts, olives and avocados.
Tips to help reduce dietary cholesterol include:
reduce the number of eggs consumed to two
per week ;
remove skin from poultry before eating;
remove fat from red meat before eating;
choose non-fat or low-fat cheeses;
limit total cheese intake to three meals
weekly;
choose broth in preference to cream-based
soups;
limit high-fat dairy foods; choose non-fat or
low-fat varieties; and
favour grilling, boiling, steaming or
microwave cooking over frying and roasting.
Increase intake of dietary fibre

This can be achieved by:
increasing consumption of fresh fruits and
vegetables; and
consuming cereals, and whole grain breads,
crackers, pasta and brown rice.
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IPIECA OGP
Reduce intake of sugars and sweeteners

Tips to reduce intake of dietary sugars include:
avoid sugar-sweetened beverages like sodas
or soft drinks, energy drinks, fruit drinks,
sweetened milk or milk alternatives;
reduce the amount of sugar added during
meal preparation or baking;
avoid foods with added sugars or sweeteners
(check labels for added sweeteners, e.g. cane
juice, glucose, maltose, fructose, high fructose
corn syrup and molasses);
limit or eliminate candy, sweets and baked
products;
favour foods such as fruits, vegetables, lean
proteins and whole grains in meals and snacks;
reduce or eliminate processed foods, which
are often high in added sugar as well as fats
and sodium (salt).
Increase consumption of fruits, vegetables,

legumes and nuts
Promoting healthy
food in companycontrolled catering
facilities can help to
encourage good
health in the
workplace.
22
Adequate consumption of fruit, vegetables and

legumes (beans, lentils, peas, etc.) reduces the risk
of cardiovascular disease, some cancers and other
chronic diseases, such as obesity and type 2
diabetes. Nuts are high in monounsaturated fat,
and can help to reduce the bad cholesterol and
prevent heart disease. Tips include:
eat plenty of fruit and vegetables;
aim for 1/2 cup of legumes at least four times
weekly; and
choose fresh or dry roasted, unsalted nuts

and natural peanut butter for maximum heart
protection. Avoid sugared, salted or oil
roasted varieties.
Substitute plant protein for animal protein

Replacing animal protein with plant protein and
fish can provide a range of health benefits and
reduce the risk of CVD. Tips include:
choose legumes, dark leafy green vegetables
or quinoa as good sources of plant protein;
reduce intake of animal proteins; and
eat more non-fried fish.
Further advice
General advice for encouraging a healthy eating
plan includes the following:
Skipping meals is not recommended
Divide calories into 46 smaller meals.
Avoid heavy meals before going to sleep.
Practice portion control an awareness of
the recommended portion sizes for certain
types of foods can help maintain a good
eating plan.

Oil and gas companies can have a positive
impact on the nutrition environment by
providing a worksite that is physically designed
to encourage good health. Examples include:
Increasing the visibility and availability of
healthy food options where food is provided
in the workplace (e.g. in vending machines,
cafeterias, snack bars, common areas, and at
meetings and company-sponsored events.
Utilizing marketing techniques at the point of
sale in company cafeterias to promote healthy
diet and food choices. Social marketing
techniques can be helpful in this respect.
Providing adequate resources for refrigeration
and heating of foods so that employees can
bring healthy meals to work from home.
Alcohol
esophagus, pancreas, colon and rectum) and
damages the liver, leading to cirrhosis.
Even moderate drinking affects cognitive
functioning; binge drinking and excessive
repeated consumption can cause brain damage
such as memory loss. Alcohol reduces libido and
sexual performance and, along with smoking, is a
major cause of impotency. Exposure of fetuses to
alcohol during pregnancy is the primary cause of
birth defects, especially for cognitive development.
Alcohol is a drug that can lead to dependency
and cause withdrawal symptoms. Dependence
on alcohol, i.e. alcoholism, is a progressive
disease that can be fatal.
Alcohol contains nothing of nutritional value

no vitamins, no minerals and no proteins. But
with seven calories per gram, it does contain a lot
of calories. One standard-size glass of wine,
whisky or beer contains 12 grams of alcoholthe
equivalent of 84 calories. This explains why heavy
drinkers gain weight and develop a beer belly.
Chronic or excessive consumption of alcohol
causes digestive problems (gastritis, gastric
ulcers, and pancreatitis), increases the risk of
digestive cancers (mouth, tongue, throat,
Drinking alcohol also increases the likelihood of

having a driving accident because of decreased
awareness, visual perception, reflexes and overall
performance. Brain activity is slowed while
reaction time is increased, which explains the
high number of alcohol-related traffic fatalities.
A glass of wine or beer every now and then is fine
for many people. It can reduce tension and stress
and help people to relax. Certain studies indicate
that moderate drinking may have cardiovascular
benefits. However, it should also be remembered
that alcohol consumption can lead to increased
blood pressureone of the most important risk
factors for cardiovascular disease.
Alcohol contains nothing of value as far as

nutrition is concerned. Despite the fact that
some studies indicate that moderate drinking
may have cardiovascular benefits, alcohol is a
drug; even moderate drinking affects cognitive
functioning, whilst drinking in excess increases
cardiovascular risk.
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Lack of sleep
Lack of sleep is a worldwide problem which
began with the invention of the electric light
bulb and has become increasingly prevalent
with the advent of modern screen-based
technology (e.g. televisions, computers,
smartphones, tablets, etc.).
Sleep disorders
There are many types of sleep disorders,
including insomnia, sleep apnoea, restless leg
syndrome, narcolepsy and circadian rhythm
disorders. Two of the most common are:
Insomnia: the inability to fall asleep or remain
asleep. This results in the sufferer not getting
the amount of sleep needed to wake up
feeling rested. This is the most common
sleep-related complaint.
Sleep apnoea: the most common type of
sleep apnoea is obstructive sleep apnoea
(OSA). OSA is responsible for pauses in
breathing accompanied by snoring, fatigue
the following day, decreased alertness and
heart attacks. The problem is often noticed by
the individuals partner and can be confirmed
by sleep studies.
How sleep affects your heart

The average sleep requirement for adults is
considered to be around 7 to 8 hours, although
what is considered normal sleep varies from one
person to another. The actual amount of sleep a
person needs will depend on various factors,
including age and genetics.
Insufficient sleep can contribute to:
heart disease;
heart rate modifications;
insulin resistance (which can lead to type 2
diabetes and obesity);
compromised immune response; and
hormonal imbalance.
24
Practical behavioural changes

While some sleep disorders require a visit to a
sleep specialist, individuals with minor sleep
disturbances can improve some problems on
their own. Recommendations to help overcome
sleep disturbances include the following:
Keep a sleep diary to track your symptoms
and sleep patterns. This can create a starting
place for dialogue with your physician or a
specialist.
Improve your sleep hygiene and daytime
habits:
Develop a bedtime routinethis will teach
your body to wind down before sleeping.
Keep a regular sleep schedule, including
during weekends.
Use a timer to record TV programmes that
are broadcast after scheduled bedtime, and
turn off gadgets before going to sleep.
Use the bedroom only for sleeping and sex.
Set aside enough time for sleep. Most
people need at least 7 to 8 hours to enable
them to wake up feeling refreshed.
If problems and stress are contributing to
lost sleep, develop a relaxation plan, e.g.
exercising regularly early in the day can
improve sleep at night by reducing stress.
Dont go to bed hungry; but be cautious of
overeating, since indigestion may disrupt
sleep.
Drink caffeinated beverages in moderation
and avoid alcohol at bedtime. The effects of
caffeine can take up to eight hours to
subside and alcohol can act as a stimulant.
Shift workers may need to explain to
friends and family the importance of
getting sufficient sleep, and the
consequences of tiredness on health and
safety.
Before bed, avoid the use of alcohol and
medicines, such as sleeping pills.
Eat sensibly, exercise, and maintain a
healthy body weight.

Disrupted sleep and fatigue have had a
significant impact on employee health and safety
at the worksite as well as on worker productivity.
A Fatigue Risk Management System (FRMS) can
identify sleep issues among employees and
reduce accident and injury rates significantly.
FRMSs need to be incorporated into corporate
policies and standards.
Sleep management is an integral part of an
FRMS which includes:
workload-staffing balance;
shift or duty rest scheduling;
employee fatigue training;
sleep disorder management;
workplace environment design; and
alertness monitoring and links to fitness for
duty.
Senior leadership should acknowledge the

importance of the issue and actively provide
their support in addressing it. Senior leaders
should ensure that the workforce is provided
with education and awareness about managing
fatigue-related risks associated with shift-work.
Additionally, leaders should support the
environmental changes needed to reduce the
risks to safety.
Identification of the environmental issues, and
elimination of associated risks, are critical when
addressing fatigue. For example, important
questions may include:
Do production platform sleeping quarters
provide an optimal place for sleeping; is the
temperature optimum; is it too noisy; and is
there a TV located in the room?
If sleep schedules are specified for shift
workers, are they successful in optimizing
sleeping patterns or do they hinder them?
Ideally, an FMRS will also include:

appropriate staffing levels and hours of work
limits;
fatigue identification, sleep management and
alertness training;
accountability and regular review structures;
continuous improvement processes; and
metrics.
Fatigue can have

a significant
impact on
employee health
and safety at the
worksite as well
as on worker
productivity.
25
IPIECA OGP
Stress
Stress is a normal part of life and is fundamental
to successful human performance. Stress can
give us a push to do our best in challenging
situations and to increase and maximize
performance and productivity. However,
unalleviated stress can affect our bodies, minds
and behaviour.
Unmanaged stress can lead to an increase in the
risk of heart disease. Learning how to recognize
the signs of stress and taking action to reduce its
harmful effects are important steps to
maintaining a healthy cardiovascular system.
What is stress?
Stress is the bodys reaction to any change that
requires an adjustment or response. The body
reacts to these changes with physical, mental
and emotional responses. There are two main
types of stresspositive and negative.
Positive stress typically results in an increase in
performance, focus and efficiency, while
negative stress is either an ongoing cycle that
becomes a way of life or a singular heightened
response to a situation where the stress
response is not called for (i.e. heightened stress
to being stuck in trafficas if our lives were in
danger when no danger exists).
Chronic stress,
resulting from the
pressures of
modern-day living,
can have a
prolonged
detrimental effect
on the body if not
addressed.
26
Stress is affected by emotional and external

factors. Emotional factors involve a persons
evaluation of stressors, real or imagined. Examples
are hostility, anger, depression and anxiety.
External factors are stressors in ones environment,
such as natural disasters, work, change and
uncertainty, disease, marital and financial
problems, responsibility for others, everyday
annoyances and frustrations that accumulate and
overwhelm.
Stress can affect a person both instantly (acute
stress) and over a period of time (chronic stress),
as described below:
Acute stress: this occurs when a person is
faced with an immediate threat or a need to
adapt, for example in the event of a personal
attack or a sudden noise. The threat may be
an actual danger or just something that is
perceived as threatening. The acute stress
response is commonly referred to as the fight
or flight response, and is inherited from our
distant ancestors who would frequently have
had to either fight or flee to protect
themselves from attack by marauding
invaders or wild animals.
Chronic stress: this is ongoing and often
results from stressors encountered in modern
day living, such as financial concerns, job
pressures or relationship problems. This type
of stress suppresses the fight or flight
response, resulting in prolonged responses in
the body that prevent recovery and repair.
Each individual responds to lifes problems,
difficulties and everyday annoyances in their
own personal ways. For example, given the same
situations, some individuals will respond with
frustration and anger while others remain
relaxed and even-tempered. Evidence suggests
that it is the individuals reaction to situations,
crises and everyday eventsrather than the
stress itselfthat is the real problem.
How stress affects the heart

Stress alone does not provoke heart attacks. It is
the individuals poor response to stress over time
that can lead to heart disease.
Stress is also known to worsen other risk factors
such as high levels of cholesterol and high
blood pressure. Stress changes the way blood
clots develop and can increase the risk of a
heart attack if it continues without relief.
Frequently, many factors cluster together to
increase disease risk. For example, when people
are under stress their blood pressure goes up,
they may overeat and exercise less, and they
may be more likely to smoke.
Poor responses to stress often include increased
smoking, excessive eating, increased caffeine
intake, lack of sleep, increased alcohol and drug
abuse including excessive use of tranquilizers
and sleeping pills.
Good responses to stress include healthy eating,
physical activity and relaxation periods, and
sufficient sleep.
Warning signs of stress

Common signs and symptoms of stress include:
physical signs: dizziness, general aches and
pains, grinding teeth, clenched jaws,
headaches, indigestion, muscle tension,
difficulty sleeping, racing heart, ringing in the
ears, stooped posture, sweaty palms,
tiredness, exhaustion, trembling, weight gain
or loss, upset stomach;
mental signs: constant worry, difficulty
making decisions, forgetfulness, inability to
concentrate, lack of creativity, loss of sense of
humour, poor memory;
emotional signs: anger, anxiety, crying,
depression, feeling powerless, frequent mood
swings, irritability, loneliness, negative
thinking, nervousness, sadness; and
behavioural signs: bossiness, compulsive

eating, critical attitude towards others,
explosive actions, frequent job changes,
impulsive actions, increased use of alcohol or
drugs, withdrawal from relationships or social
situations.
Employees role in stress reduction

There are a number of ways in which the
employee can manage his or her response to
stress. Some useful recommendations include:
healthy eating;
drinking in moderation;
regular activity and/or exercise;
avoiding excessive caffeine intake and the
consumption of energizing drinks;
smoking cessation; and
ensuring adequate sleep and rest.
Additional recommendations include:
knowing and accepting ones limits;
recognizing and admitting to ones mistakes;
asserting oneself and assuming responsibility;
managing time effectively;
setting priorities;
thinking positively and setting realistic
personal goals and expectations; and
taking advantage of support groups,
including family, friends, colleagues, etc.
Stress can manifest

itself in a variety of
physical, mental,
emotional and
behavioural ways,
and in severe cases
can lead to more
frequent use of
alcohol and drugs,
thereby increasing
cardiovascular risk.
27
IPIECA OGP
Good relationships
with management
and colleagues, and
a recognition of
employees
commitments and
responsibilities are
important aspects
of managing
workplace stress.

Workplace leaders and managers are architects
of the work environment and need to attend to
those elements in the workplace that can
contribute unnecessarily to unalleviated stress.
Below are some specific areas that workplace
leaders need to pay attention to:
Control over work: How much do employees
or workers actually understand about their
work? How engaged are they in the goals of
the work? How much control do they have
over how the work gets done? Are employees
working hours monitored with the aim of
avoiding excessive time spent working?
Roles and responsibilities: Do workers
understand their roles and how their
responsibilities fit with the roles of their
co-workers?
Communications: Does the workplace have a
commitment to clear and regular
communications about changes in the work
or organization? Is management available for
regular communications with employees?
28
Diversity: Is the workplace free from

prejudice, bullying and harassment? Are
workers open to, and respectful of, each
others differences?
Recognition of positive performance: Is the
workplace an environment where the
achievements of work teams and individual
workers are celebrated and recognized?
Conflict management: When differences
arise between workers, is there a clear avenue
for the reconciliation of these differences?
Work/life balance: Is the company cognizant
of work/life boundaries? Do employees
perceive that managers and leaders
appreciate and honour the fact that they have
personal responsibilities and commitments?
These workplace variables are key to the

development of an environment where
unnecessary stress is reduced.
The ageing workforce and cardiovascular risk

It is not easy to define an older worker. The WHO
defines 45 years and over as the dividing line
between younger and older workers.
musculoskeletal disorders, cancer, kidney

diseases). These medical issues can be
responsible for work limitations or restrictions.
Ageing is not a disease but a biological process

that starts at birth. Although exercise, a proper
diet and good lifestyle choices have been shown
to slow down the ageing process, they cannot
reverse it.
Emphasis should be placed on the

implementation of employee wellness
programmes that can contribute to allowing the
ageing workforce to work and be productive for
a prolonged period of time.
In general, individuals may not have the same

strength or physical abilities at age 50 or 60 that
they had at 25 or 30.
Health assessments and fitness-for-task

examinations should place adequate emphasis
on the following in the ageing population:
blood pressure and the cardiac function;
musculoskeletal strength;
coordination and physical flexibility;
visual acuity;
hearing; and
potential side-effects of medication taken for
chronic illness.
However, age should not determine fitness to

work. There can be a significant difference
between the employees chronological age and
their physiological age. For example, a 60-yearold individual may be fitter than a 40-year-old.
Characteristics of the older

workforce
The consensus is that knowledge, skills and
experience are advantages for retaining older
workers. Older employees also have the
potential to provide training as well as to act as
role models for the younger generation of
employees.
The oil and gas industry will be faced with an

ageing workforce in the coming years as the
number of older workers continues to increase
relative to the number of younger employees.
Older workers are potentially as adaptable and

flexible in learning new technologies and coping
with change and stress as the younger
workforce.
However, duration of absenteeism and recovery
may be more significant and costly following
injury or illness in employees over 45 years of age.
The ageing process will result in increased
arteriosclerosis (hardening of the arteries),
hypertension and increased frequency of
cardiovascular illnesses (heart attacks and
strokes) as well as an increased frequency of
other chronic diseases (e.g. diabetes,
Age should not

determine fitness to
work: a 60-year-old
individual can be
just as physically fit
as a 40-year-old,
and knowledge,
skills and experience
are good reasons for
retaining older staff.
29
IPIECA OGP
What oil and gas companies can do to address the risk

of cardiovascular disease
Why should companies address the

issue?
The global trend among young people today is
towards getting fatter, eating more junk food,
drinking more soft drinks, increasing screen time
and reducing physical activity. The generation of
new employees coming into the oil and gas
industry reflects this worldwide trend.
It is essential for companies to put in place riskbased health promotion programmes that are
capable of addressing this lifestyle problem.
Without such efforts, the repercussions in years
to come are likely to have a negative impact on
the industrys business.
What can companies do?
Specific recommendations appear continuously

throughout this document. General examples of
how companies can promote well-being and
reduce cardiovascular risk factors include:
effective company leadership and
commitment;
health assessments and screening;
awareness, education and training;
promotion of risk factor reduction,
addressing:
smokingsmoking cessation programmes;
no-smoking environments;
30
foodcontracting catering companies that

are capable of implementing healthy
eating programmes (e.g. using less salt, less
fat, less sugar, more vegetables, more fruit,
tasty and attractive foods, etc.);
beveragesdiscourage soft drinks and
provide a plentiful supply of fresh water;
alcoholprovide education on the risks
and effects;
inactivityencourage fitness days; promote
the use of gyms and fitness clubs; promote
walking, including the use of stairs;
stressfocus on prevention and managing
the root causes of work-related stress at the
organizational level; provide training and
awareness at the employee level, and
access to counselling where possible; and
fatigueoperate an effective fatigue
management system.
involving families where possiblee.g.
inviting families to fitness days; encouraging
spouses and families to favour healthy food
options when shopping, cooking and eating.
Initiatives to promote well-being need to be

sustained over the long term. It is essential to
understand that the risk of cardiovascular disease
is a global problem and is likely to worsen in the
oil and gas industry over the coming years. Data
on the issue should be collected over time and
used to coordinate ongoing efforts and provide
feedback to management.
Conclusion
Within the oil and gas industry, heart attacks and
strokes are the primary cause of nonoccupational deaths. Globally, they surpass the
number of motor vehicle accidents by a factor of
10. Thirteen million people died of heart attacks
and strokes in 2011.
Awareness and prevention of cardiovascular
diseases, although a non-occupational problem,
can have a positive impact on business; it is
therefore imperative that effective health
management programmes which address this
issue are developed and sustained within the
industry.
cardiac risk factors are identified and where
steps can be implemented to provide treatment
or remediation. However, it must clearly be
understood that the onus of prevention and
treatment rests on the individual and not on the
company or industry.
A regular health assessment is recommended for

workers to help identify the existence of
potential risk factors and define an individual
action plan, which may include:
regular blood pressure checks;
smoking cessation;
reduced intake of fats, sugar and salt;
an increase in physical activity;
attaining an ideal weight;
alcohol reduction or cessation;
maintaining adequate sleep and rest;
managing stress.
Adherence to the appropriate lifestyle advice
can increase lifespan, improve quality of life and
reduce medical bills.
Healthy individuals have a greater chance of
living longer!
The oil and gas industry is unique in the fact that

work often takes place in remote locations
where medical care may be limited and specialist
treatment centres may be at a considerable
distance from the workplace.
31
IPIECA OGP
References
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35
IPIECA OGP
Glossary
Acute: having a sudden onset, sharp rise, and short
course; lasting a short time.
Alertness: attentiveness; watchfulness; mental
responsiveness.
Arteriosclerosis: a general term which refers to the
thickening and hardening of the arteries due to age
and raised blood pressure.
Atherosclerosis: also known as arteriosclerotic
vascular diseasea condition in which an artery
wall thickens as a result of the accumulation of
fatty materials such as cholesterol.
Biomarker: a characteristic that is objectively
measured and evaluated as an indicator of normal
biological processes, pathogenic processes or
pharmacologic responses to a therapeutic
intervention.
Chronic (condition): a condition or disease that is
persistent or otherwise long lasting in its effects
(usually for more than three months). In medicine,
the opposite of chronic is acute.
Circadian rhythm: physical, mental and behavioural
changes that follow a roughly 24-hour cycle, and
respond primarily to light and darkness in an
organisms environment.
C-reactive protein: a protein found in the blood. Its
increase usually indicates an inflammation.
Etiologic factor: a factor or condition that may be
involved in the development of a disease.
36
Immune response: how the body recognizes and

defends itself against bacteria, viruses and
substances that appear foreign and harmful.
Inflammatory: related to inflammation; the signs of
inflammation are redness, swelling, pain and a
feeling of heat.
Insulin resistance: a condition where the body
produces the hormone insulin but does not use the
insulin effectively.
Legumes: plants sharing a common trait of having
seeds growing in pods, e.g. beans, lentils, peas and
nuts.
Lifestyle: a wide concept that analyses the way of
life of a person as a whole, in terms of the physical,
mental, spiritual and social aspects of life both at
home and at work. A persons lifestyle is one of the
determinants of their health.
Maltose, or malt sugar: a sugar formed from two
units of glucose.
mg/dl: milligram per decilitrethe unit used in
medicine to measure the concentration of substances
in the blood. 1 mg/dl equals 0.01 grams per litre (g/l).
mmol/l: millimole per litrethe SI unit used in
medicine to measure the concentration of
substances in the blood.
Molasses: a by-product of the refining of sugar
cane, grapes, or sugar beets into sugar.
Fatigue: physical or mental weariness.
Monounsaturated (fats): fats with only one double

bond in the fatty acid chain.
Fructose, or fruit sugar: a simple sugar found in

many plants.
Nicotine: toxic substance found in tobacco.
Glucose: a simple sugar found in plants; also

known as D-glucose, dextrose or grape sugar.
Narcolepsy: chronic neurological disorder caused

by the brains inability to regulate sleep-wake cycles
normally.
High fructose corn syrup: any of a group of corn

syrups where enzymatic processing converts some
of its glucose into fructose in order to produce a
desired sweetness.
Obstructive sleep apnoea (OSA): sleep apnoea

caused by a blockage of the airway, usually when
the soft tissue in the back of the throat collapses
during sleep.
Osteoporosis: disorder characterized by the

dwindling of bone mass due to loss of calcium,
especially in post-menopausal women, but can also
be found in men.
Pedometer: a device for measuring the distance
walked.
Polyunsaturated (fats): fatty acids that contain
more than one double bond in their backbone.
Processed foods: foods altered from their natural
state, either for safety or for convenience reasons
through canning, freezing, refrigeration,
dehydration or aseptic processing. While some
processing may improve safety (like pasteurization)
and nutritional quality (freezing of fruits and
vegetables, and vitamin fortification), some
processed foods contain trans fats (trans-fatty
acids) and the addition of additives, sugar or salt.
Productivity: a measure of the efficiency of
production; the rate at which one is productive.
Quinoa: a high protein seed used as grain in
cooking.
Restless leg syndrome: a neurological disorder
characterized by an irresistible urge to move ones
body to stop uncomfortable or odd sensations.
Risk factor: any attribute, characteristic or exposure
of an individual that increases the likelihood of
developing a disease or injury. Some examples of
the more important risk factors are poor nutrition,
unsafe sex, high blood pressure, tobacco and
alcohol consumption, as well as unsafe water, and
poor sanitation and hygiene.
Stethoscope: an instrument used for listening to

sounds produced within the body.
Stimulant: any agent that temporarily arouses or
accelerates physiological or organic activity.
Stressor: an emotional or environmental stimulus
that causes stress in an individual.
Target organ: the organ whose activity levels
demonstrate a change in the course of a disease.
Trans fat (also trans-fatty acid): an unsaturated
fatty acid of a type occurring in margarines and
manufactured cooking oils as a result of the
hydrogenation process, having a trans arrangement
of the carbon atoms adjacent to its double bonds.
Consumption of such acids is thought to increase
the risk of atherosclerosis.
Unalleviated: relentless; without lessening or relief.
Urbanization: growth of urban areas as a result of
migration of rural suburban populations into cities.
Whole grain: cereal grains that contain cereal germ,
endosperm and bran, in contrast to refined grains,
which retain only the endosperm. Includes the seed
of a plant or a grass, such as a kernel of corn,
quinoa or wheat.
Withdrawal symptoms: group of physical and/or
mental symptoms that occurs upon the abrupt
discontinuation, interruption or decrease of certain
medication, illicit drugs and addictive substances,
including alcohol.
Social marketing: in the catering/foodservice

industry this refers to use of the four Ps
products, placement, promotion and price, i.e.
products that are healthy and appealing; placement
of healthy foods in easily accessible locations;
promotion strategies that inform and encourage
selection; and pricing foods to encourage their
purchase.
37
IPIECA OGP
Appendix 1: Workplace health promotion (or cardiovascular

prevention) checklist
To be completed by company-approved health professional
Yes
No
N/A
Comments
Company vision/mission for a health promotion programme

at work with management commitment
1
Are clear health promotion programme goals and objectives

defined and implemented at the workplace?
Is there visible management and leadership commitment?
Are adequate resources set aside for supporting health

promotion programmes at the workplace?
Are roles and responsibility for managing the health

promotion programmes at the workplace clearly defined?
Health education and health promotion activities

1
Are regular health talks provided by subject matter experts?
Are health promotion activities regularly organized?
Are regular, voluntary sports activities with/without families

regularly organized?
Are regular voluntary spot check activities for (biometrics)

blood pressure, blood sugar and cholesterol regularly
organized?
Is counselling available for management of stress and

psychosocial problems?
Drug and alcohol policy

1
Does a drug and alcohol policy exist in your company and is it

implemented worldwide?
Where legally applicable does your company perform random

drug and alcohol testing?
Does your company provide a drug and/or alcohol

rehabilitation programme?
No-smoking policy
1
Does a non-smoking policy exist in your company and is it

implemented worldwide?
Is there a provision for rehabilitation services and for smoking

cessation treatments/clinics?
Is the workplace a smoke-free zone, including company

vehicles?
continued
38
Yes
No
N/A
Comments
Health promotion facilities

1
Are in-house exercise facilities or fitness centres available?
Does work flexibility exist to allow time to support employee

exercise (e.g. gym, fitness programme)?
Does the company subsidize health promotion facilities for

employees (e.g. the 10,000 steps a day programme)?
Food and healthy eating

1
Is a dietician available in the catering company for creation of

company menus?
Is a healthy food option always available in companysponsored eating facilities?
Is a healthy option available in vending machines located in

company premises?
Are fruits freely available during breaks, and is there a healthy

food and drink option during meetings?
Is training provided in healthy eating and good food habits?
In vending machines located in company premises, does the

pricing of healthy foods encourage their consumption?
Medical/occupational health services

1
Is there a provision for regular health/health promotion

checkups?
Is there a company-promoted follow-up for chronic medical

condition (e.g. diabetes, high blood pressure, etc.)?
Are automatic external defibrillators readily available for public

use and are employees trained in their use?
Is there a sufficient provision of trained first-aiders in each

location?
Is there on-site availability of Medical Emergency Response

support?
Is there a company-provided voluntary health risk assessment

option available for employees and dependents?
Measuring health promotion impact

1
Are metrics in place to measure and understand short-term

and long-term benefits of the companys health promotion
programme (e.g. reduced absenteeism, cardiovascular
incidence rate, etc.)?
39
H-factor Program
What is H-factor Program?
H-factor Health factor - is a lifestyle and nutritional
program which proposes you, among others, a different food, as
tastier as, but healthier than regular food on site. Its menus are
balanced and based on the latest scientific information, being the
result of cooperation among catering company and Saipem
Health Department. Menus contain the right quantity of calories,
nutrients, vitamins and minerals in order to keep you fit and
healthy. They might be adapted to your job position or type of
work (concerning number of calories) as well as to different
health conditions you may have, such as dyslipidemia, high blood
pressure, diabetes or overweight.
Why H-factor Program?
An old saying affirms that You ARE
what you EAT. Over 90% of the diseases
known to man are caused by improper
foodstuffs. It has been proven that
cardiovascular diseases, diabetes or many
forms of cancers are strongly related with
food and food habits. Overweight and obesity are more frequent
nowadays than in past time due to increase consumption of
hyper caloric food. Many people choose to eat unhealthy food (so
called junk food) due to wrong information, fashion or
promotional advertisement. H-factor program gives you the
possibility to choose a better food for your health and well-being.
What about H-factor menus?
Dedicated menus will be prepared on fortnightly basis by
experienced and trained cooks. The food will be offered during
regular meals, in easily identifiable serving area. The H-factor
food will be easily identifiable also through H-factor logos, posted
in visible places above or next to dedicated serving area or
labeled on dishes and menus. More information about menus is
available through trained catering staff (who may wear the
specific programs logo), medical personnel and programs
dedicated place/corner on site. H-factor menus are based on so
called Mediterranean food.
What is Mediterranean food?
Scientific studies indicate that
ingredients of this diet are the best options
for a healthy food. It is not specifically
Italian and may be found in many other
countries around Mediterranean Sea (Italy,
Greek, Spain, France, Algeria, etc.). This
diet is based on fresh products, vegetable
fats (especially extra virgin olive oil), white meat (especially fish),
legumes, vegetables and cereals (whole grains). Its basic
components are used to create menus according to different
cuisines, customs or requests.
Rev. 02 Last updated March 2012- Saipem MEDES
Who may participate in H-factor?

All people on site, regardless their
position or health status, can join to H-factor
program. Participation is not mandatory
but strongly recommended. You are free
to choose anytime what type of food you
want to eat (regular or H-factor) but desired
results, such as weight loss, lower blood
pressure, etc., depend on your adherence to the program.
Who may be especially interested in?
People may have different benefits in attending H-factor,
such us improvement of life style or losing weight (for overweight
individuals). People with health risk factors (e.g. high
cholesterol), cardiovascular diseases, (e.g. high blood pressure)
or diabetes, who are indicated to follow a specific diet, should
choose H-factor menus which may meet their clinical profile and
recommendations. Ask medical personnel on site for specific
recommendations about food, which could be suitable to your
condition or special health status you may have.
I want to join H-factor! What is the next step?
Establish yourself the real motivation
for joining the program and read more
information about from available materials.
After that, establish yourself, if possible,
specific goals of your participation. Visit
the site doctor, get detailed information
regarding the program execution and ask him, if necessary, for a
qualified advice. For specific consultation, you may contact other
professionals you prefer, such as home country doctor /
nutritionist. During the meal, choose/ask for food marked with Hfactor logo, according to your plan, recommendations and/or your
clinical profile.
H-factor logo
The logo should guide your participation in
program and will be posted in different visible
places at operating site (e.g. above H-factor food
serving area in mess room; next to programs
Corner and measuring device; on uniform of catering staff
involved in H-factor, as labels on dishes and menus containing
H-factor food or on other informative materials concerning Hfactor program (such as leaflets about diets, menus, advices
about losing weight, etc.). Look for and follow this sign if you
decide to participate and/or want more information about Hfactor!
And the next step?
Try to respect applicable recommendations as much as
possible and attend the follow-up program. Follow-up program
assesses the improvements which H-factor brings in your life and
health. You will be asked to participate in surveys about the taste

and quality of food and you may be involved, only with your
informed consent, in biological monitoring (e.g. cholesterol
measurement for those with high cholesterol or periodical
evaluation of Body Mass Index for those who want to lose
weight). The follow-up program will be established by doctor on
site, according to your availability, preferences and needs. Each
participant is free to choose his individual involvement in H-factor
program, but once involved, he must follow it!
H-factors Corner on site
A dedicated H-factor Corner is to be available at operating
site and will include a Body Mass Index (BMI) assessment device
and other informative materials about the program. Using the
device, everyone can assess his BMI. Once BMI is calculated,
the result is printed on a piece of paper. You may evaluate
yourself your nutritional status using BMI tables also available at
the Corner. Depending on result, further measurements may be
recommended by medical personnel on site.
Key points
1. H-factor comes from Health factor and it is a nutritional and
lifestyle program inside Saipem, which proposes you, as an
alternative, a healthier type of food.
2. The food may be adapted to your job position or type of work,
as well as to different health conditions you may have.
3. Every employee may join the program. Participation is not
mandatory but recommended.
4. The H-factor menus are based on Mediterranean diet and
follow the latest scientific recommendations.
5. Dedicated menus will be prepared on fortnightly basis by
experienced and trained cooks.
6. People are free to choose anytime what type of food they
want to eat: regular food or H-factor food.
7. Look for and follow the H-factor logo if you decide to
participate and/or want more information about the program.
8. A dedicated H-factor corner is to be available at the operating
site. This place will have a Body Mass Index device which will
help you in assessing your nutritional status.
9. Qualified health advice should be requested and medical
personnel on site are ready to guide you, before and during your
participation in H-factor program.
Bon appetite
and
Enjoy your
food!!!
Figure 1: BMI assessment device and an example of printed result, after BMI
measurement.
What is Body Mass Index (BMI)?

BMI is a good indicator of ones health and nutrition status.
After BMI assessment, you may consult below table. It is
recommended to ask for a professional advice and to join Hfactor if your BMI is not in normal range (below 18.5 or over 25).
BMI = weight (kg)/ height2 (m2)
< 16
Severely thinness
16 16.99
Moderate thinness
Underweight
17 - 18.49
Mild thinness
18.5 - 24.99
Normal weight
25 - 29.99
Preobese
30 - 34.99
Obese class I
Overweight
35 - 39.99
Obese class II
40
Obese class III
. Table 1: BMI values and their meaning (Source: WHO)
Rev. 02 Last updated March 2012- Saipem MEDES
Do you have any further questions?

Are you interested in a healthier style of life?
Are you overweight and want to lose weight?
Do you want to evaluate your nutritional status?
Do you want to improve your physical and intellectual
performances?
Have you been told that you have some risk factors for
cardiovascular diseases or diabetes?
Have you or one of your close relatives been diagnosed with
a cardiovascular disease or diabetes?
Have you been recommended a certain diet such that for
high blood pressure or high cholesterol?
Do you want to join H-factor program?
If the answer to ANY of these questions is YES, then:
contact nearest Saipems doctor and/or catering staff;
visit H-factor Corner on site, assess your Body Mass Index
and find more information about the program;
attend different presentations/lectures kept on site by
medical personnel concerning health topics and H-factor
program;
visit dedicated Health page on Saipem intranet;
simply call Saipems Pronto Dottore at:
+ 39 02 520 34 777.
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Healthy workplaces:
a model for action
For employers, workers, policy-makers
and practitioners
i | Healthy workplaces: a model for action
WHO Library Cataloguing-in-Publication Data

Healthy workplaces: a model for action: for employers, workers, policymakers and practitioners.
1.Occupational health. 2.Health promotion.
3.Workplace - standards. 4.Occupational diseases prevention and control. I.World Health Organization.
ISBN 978 92 4 159931 3
WA 440)
(NLM classification:
World Health Organization 2010

All rights reserved. Publications of the World Health
Organization can be obtained from WHO Press,
World Health Organization, 20 Avenue Appia, 1211
Geneva 27, Switzerland (tel.: +41 22 791 3264; fax:
+41 22 791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce or translate
WHO publications whether for sale or for noncommercial distribution should be addressed to WHO
Press, at the above address (fax: +41 22 791 4806; email: permissions@who.int).
endorsed or recommended by the World Health Organization in preference to others of a similar nature
that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.
All reasonable precautions have been taken by the
World Health Organization to verify the information
contained in this publication. However, the published
material is being distributed without warranty of any
kind, either expressed or implied. The responsibility
for the interpretation and use of the material lies with
the reader. In no event shall the World Health Organization be liable for damages arising from its use.
Printed in Switzerland
The designations employed and the presentation of

the material in this publication do not imply the expression of any opinion whatsoever on the part of the
World Health Organization concerning the legal
status of any country, territory, city or area or of its
authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent
approximate border lines for which there may not yet
be full agreement.
The mention of specific companies or of certain
manufacturers products does not imply that they are
DESIGN & LAYOUT

Philippos Yiannikouris
the health of workers.

Dr Maria Neira, Director, Department of Public Health and Environment,
World Health Organization
COVER
Vertical Job. Photographer: Francisco Monterro, USA. Safe
equipment and safe behaviours are both essential to preventing occupational risks associated with hazardous tasks
(2nd prize in the WHO/Pan American Health Organization
(PAHO) photo contest 2010, My work, my health)
OVERLEAF
Men's job, women's job. Young workers in a pottery
workshop in Amman, Jordan, 1993 ILO
ii | Healthy workplaces: a model for action
The wealth of business depends on
iii | Healthy workplaces: a model for action
Contents
....................................................................................... iv
Introduction
..................................................................................... 01
I. Why develop a healthy workplace

initiative?
..................................................................................... 04
II. Definition of a healthy workplace
..................................................................................... 06
III: Healthy workplace processes and

avenues of influence
..................................................................................... 07
IV. The content: avenues of influence for a

healthy workplace
..................................................................................... 09
V. The process: initiating and sustaining a

programme
..................................................................................... 15
VI. Underlying principles: keys to success
..................................................................................... 21
VII. Adapting to local contexts and needs
..................................................................................... 24
References
..................................................................................... 25
Acknowledgements
..................................................................................... 26
iv | Healthy workplaces: a model for action
Contents
01 | Healthy workplaces: a model for action
Introduction:
a model for action
Workers health, safety and well-being are vital

concerns to hundreds of millions of working
people worldwide. But the issue extends even
further beyond individuals and their families. It is
of paramount importance to the productivity,
competitiveness and sustainability of enterprises,
communities, and to national and regional economies.
Currently, an estimated two million people die
each year as a result of occupational accidents
and work-related illnesses or injuries (1). Another 268 million non-fatal workplace accidents
result in an average of three lost workdays per
casualty, as well as 160 million new cases of
work-related illness each year (2). Additionally,
8% of the global burden of disease from depression is currently attributed to occupational risks
(3).
These data, collected by the International Labour
Organization and the World Health Organization, only reflect the injuries and illnesses that
occur in formally registered workplaces. In many
countries, most workers are employed informally in factories and businesses where there are
no records of work-related injuries or illnesses,
let alone any programmes to prevent injuries or
illnesses. Addressing this huge burden of disease,
economic costs and long-term loss of human
resources from unhealthy workplaces is a formidable challenge for national governments, eco-
nomic sectors, and health policy-makers and

practitioners.
In 2007 the World Health Assembly of the
World Health Organization endorsed the Workers health: global plan of action (GPA) to provide
new impetus for action by Member States. This is
based upon the 1996 World Health Assembly
Global strategy for occupational health for all. The
2006 Stresa Declaration on Workers Health, the
2006 Promotional framework for occupational health
and safety convention (ILO Convention 187) and the
2005 Bangkok charter for health promotion in a
globalized world also provide important points of
orientation.
The Global Plan of Action sets out five objectives:
1) To devise and implement policy instruments
on workers health;
2) To protect and promote health at the workplace;
3) To promote the performance of, and access
to, occupational health services;
4) To provide and communicate evidence for
action and practice;
5) To incorporate workers health into other
policies.
In line with the Global Plan of Action, this brochure provides a framework for the development of healthy workplace initiatives adaptable
to diverse countries, workplaces and cultures.
OVERLEAF
The strength of teamwork . Photographer: Andrs Bernardo
Lpez Carrasco, Mexico. Workers in a warehouse lift a
heavy metal structure in unison to prevent injury (1st prize
in the WHO/Pan American Health Organization (PAHO)
photo contest 2010, My work, my health)
BELOW
Humanizing work. Photographer: Marcelo Henrique Silveira,
Brazil. A nurse in a Brazilian hospital takes time to read to a
patient, offering a moment of mutual enjoyment (3rd prize in
the WHO/Pan American Health Organization (PAHO)
photo contest 2010, My work, my health)
Subsequently, practical guidance specific to sectors, enterprises, countries and cultures will be
developed by WHO, in collaboration with countries, experts and stakeholders.
The review of this evidence is available in a 2010

background document, Healthy workplaces: a
global framework and model: review of literature and
practices. It is available online at:
The principles outlined here are based on a systematic review of healthy workplace programmes in the global literature, including definitions, policies and practices for improving workplace health. The documentation was reviewed
at a 22-23 October 2009 Geneva workshop involving 56 experts from 22 countries, WHO regional offices, related WHO programme representatives, an ILO representative, two international NGO representatives, and worker and
employer representatives (see acknowledgements).
http://www.who.int/occupational_health/
healthy_workplaces/en/index.html
I.
It is the right thing to do: business ethics

Personal and social codes of behaviour and ethics
are the foundation of every major religious and
moral philosophy. One of the most basic of universally accepted ethical principles is to do no
harm to others. In the workplace, this means
ensuring employees' health and safety.
Long before national labour and health regulations came into being, business entrepreneurs
learned that it was important to adhere to certain social and ethical codes related to workers,
as part of their role in the broader community
and to insure the success of their endeavours.
In the modern era, both global declarations and
voluntary organizations have emphasized the importance of ethical business practices involving
workers. The 2008 Seoul declaration on safety and
health at work (4) asserts that a safe and healthy
work environment is a fundamental human right.
The United Nations Global Compact is a voluntary
international leadership platform for employers.
It recognizes the existence of universal principles
related to human rights, corruption, labour standards and the environment.
workers' health are among the most successful

and competitive, and also enjoy better rates of
employee retention. Some factors employers
need to consider are:
a) the costs of prevention versus the costs resulting from accidents;
b) financial consequences of legal violations of
health, safety and occupational rules and laws;
c) workers' health as an important business asset for the company.
Adherence to such principles avoids undue sick
leave and disability, minimizes medical costs as
well as costs associated with high turnover such
as training, and increases long-term productivity
and quality of products and services.
Increasingly, consumer power also is being leveraged to promote healthy workplace practices.
For instance, a number of global movements of
ethics-minded entrepreneurs and consumers
have introduced commercial "fair trade" labels
appealing to developed-country consumers.
These labels aim to ensure the health and social
well-being of producers as well as environmental
safeguards in product processing.
It is the smart thing to do: the business case
It is the legal thing to do: the legal case
A wealth of data demonstrates that in the long

term, companies that promote and protect
Most countries have enacted national and even

local legislation requiring at least minimal em-
Why develop a
healthy workplace
initiative?
BELOW
Paraplegic teacher in training centre, Harare,
Zimbabwe, 1992 ILO
ployer protection of workers from workplace

hazards that could cause injury or illness. As
trade mechanisms and awareness have developed, and major industrial accidents in developing countries have received increased worldwide
media attention, many developing countries have
increased their enforcement of occupational
health codes and laws.
Businesses that fail to provide healthy work environments do not only leave employees, their
families and the public exposed to undue risks
and human suffering. In addition, their enterprises and leadership may become involved in
costly litigation under national or international
labour laws. This can result in fines or even imprisonment of managers and directors found
guilty of violations. Multinational companies that

try to cut worker health and safety costs by
moving their most dangerous industrial processes to countries where health, safety and labour legislation or enforcement are perceived as
weaker may discover that their firms and products become the focus of intense international
and media scrutiny, undermining their markets
and profitability.
II.
WHOs definition of health is: A state of complete physical, mental and social well-being, and
not merely the absence of disease. In line with
this, the definition of a healthy workplace that
was developed in the consultations that took
place around this document, is as follows:
A healthy workplace is one in which workers and managers collaborate to use a continual improvement process to
protect and promote the health, safety and well-being of
all workers and the sustainability of the workplace by considering the following, based on identified needs:
one in which workers and
health and safety concerns in the physical work envi-
managers collaborate to
ronment;
health, safety and well-being concerns in the psychoso-
use a continual
cial work environment, including organization of work

and workplace culture;
personal health resources in the workplace; and
improvement process to
ways of participating in the community to improve the

health of workers, their families and other members of
the community.
This definition reflects how understanding of occupational health has evolved from an almost
exclusive focus on the physical work environment to inclusion of psychosocial and personal
health practice factors. The workplace is increasingly being used as a setting for health promotion
and preventive health activities not only to prevent occupational injury, but to assess and improve people's overall health. Another increasing
emphasis is on workplaces that are supportive
and accommodating of older workers and those
with chronic diseases or disabilities.
A healthy workplace is
protect and promote the

health, safety and wellbeing of all workers and
the sustainability of the
workplace...
Definition of a healthy
workplace
III.
Healthy workplace
processes and avenues
of influence
To create a healthy workplace, an enterprise

needs to consider the avenues or arenas of influence where actions can best take place and the
most effective processes by which employers and
workers can take action. According to the model
described here, developed through systematic
literature and expert review, four key areas can
be mobilized or influenced in healthy workplace
initiatives:
Critical process aspects of the model include an

emphasis on a step-by-step 'continual' processes
of mobilization and worker involvement around
a shared set of ethics and values, as shown in
Figure 1. The models key content and process
components are discussed in sections IV and V.
the physical work environment;

the psychosocial work environment;
personal health resources;
enterprise involvement in the community.
To create a healthy workplace, an enterprise needs to

consider the avenues or arenas of influence where actions
can best take place and the most effective processes by
which employers and workers can take action.
Physical work environment
Mobilize
Assemble
Improve
Leadership engagePersonal
Psychosocial
work
ETHICS & VALUES
Evaluate
environment
Assess
resources
Worker involvement
Do
Prioritize
Plan
Enterprise community
involvement
health
FIGURE 1
WHO healthy workplace model: avenues of influence,
process, and core principles
IV.
The content: avenues

of influence for a
healthy workplace
Figure 2 depicts the four arenas in which actions

towards a healthy workplace can best be taken.
These are briefly described below and selected
examples of typical actions also are provided.
These avenues of influence often overlap with
one another, as the figures four overlapping circles reflect.
1. The physical work environment

The physical work environment refers to the
structure, air, machinery, furniture, products,
chemicals, materials and production processes in
the workplace. These factors can affect workers
physical safety and health as well as mental health

and well-being. In cases where workers perform
tasks in a vehicle or outdoors, those vehicles or
outdoors locations are also part of the physical
work environment.
Hazards in the physical environment typically have
the greatest potential to disable or kill workers,
so the earliest occupational health and safety
laws and codes focused on these factors. Even
so, these types of hazards still threaten workers
lives on a daily basis in developed as well as developing countries.
Physical work
Environment
Psychosocial work
Personal health
environment
resources
Enterprise
community
involvement
FIGURE 2
Avenues of influence for a healthy workplace
tos, silica, tobacco smoke);

physical hazards (noise, radiation, vibration,
excessive heat, nanoparticles);
biological hazards (e.g. hepatitis B, malaria,
HIV, tuberculosis, mould, lack of clean water,
toilets and hygiene facilities);
ergonomic hazards (e.g. processes requiring
excessive force, awkward posture, repetition,
heavy lifting);
mechanical hazards (e.g. machine hazards related to nip points, cranes, forklifts);
energy hazards (e.g. electrical hazards, falls
from heights);
mobile hazards (e.g. driving on ice or in rainstorms or in unfamiliar or poorly maintained
vehicles).
Examples of ways to influence the physical work environment: Typically, hazards must be identified,
assessed and controlled through a hierarchy of
control processes. Key steps typically include the
following:
Elimination or substitution: e.g. a factory may
opt to replace benzene, a powerful carcinogen, with toluene or another less-toxic
chemical. An office might eliminate driving in
dangerous conditions by holding teleconference meetings.
Engineering controls include installing machine
guards on stamping machines, setting up local
exhaust ventilation to remove toxic gases,

installing noise buffers and providing safe needle systems and patient lifting devices in hospitals.
Administrative controls: employers can ensure
good housekeeping, train workers on safe
operating procedures, perform preventive
maintenance on machines and equipment and
enforce smoke-free policies.
Personal protective equipment can include respirators for employees working in dusty conditions; masks, gloves and respirators for health
care workers; and hard hats and safety boots
for construction workers.
2. The psychosocial work environment

The psychosocial work environment includes
organizational culture as well as attitudes, values,
beliefs and daily practices in the enterprise that
affect the mental and physical well-being of employees. Factors that might cause emotional or
mental stress are often called workplace
'stressors'.
Examples of psychosocial hazards include but are
not limited to:
poor work organization (problems with work
demands, time pressure, decision latitude,
reward and recognition, support from supervisors, job clarity, job design, poor communication);
Problems typically include:

chemical hazards (solvents, pesticides, asbes-
OPPOSITE
Tokyo, 8 am on the way to the office, 1990 ILO
organizational culture (lack of policies and
Protect workers by raising awareness and pro-
practice related to dignity or respect for all

workers, harassment and bullying, gender discrimination, stigmatization due to HIV status,
intolerance for ethnic or religious diversity,
lack of support for healthy lifestyles);
command and control management style (lack
viding training to workers, for example regarding conflict prevention or harassment

situations.
of consultation, negotiation, two-way communication, constructive feedback, respectful

performance management);
lack of support for work-life balance;
fear of job loss related to mergers, acquisitions, reorganizations or the labour market/
economy.
Ways to influence the psychosocial work environment: Psychosocial hazards typically are identified
and assessed using surveys or interviews, as
compared to inspections for physical work hazards. A hierarchy of controls would then be applied to address hazards identified, including:
Eliminate or modify at the source: Reallocate
3. Personal health resources in the workplace

Personal health resources are the health services, information, resources, opportunities,
flexibility and otherwise supportive environment
an enterprise provides to workers to support or
motivate their efforts to improve or maintain
healthy personal lifestyles, as well as to monitor
and support their physical and mental health.
Examples of personal health resource issues in the
workplace: Employment conditions or lack of
knowledge may make it difficult for workers to
adopt healthy lifestyles or remain healthy. For
example:
work to reduce workload, remove supervisors or retrain them in communication and

leadership skills, enforce zero tolerance for
workplace harassment and discrimination.
Lessen impact on workers: allow flexibility to
Physical inactivity may result from long work
deal with work-life conflict situations, provide

supervisory and co-worker support
(resources and emotional support), allow
flexibility in the location and timing of work,
and provide timely, open and honest communication.
healthy snacks or meals at work, lack of time

to take breaks for meals, lack of refrigeration
to store healthy foods or lack of knowledge.
Smoking may be allowed or enabled by work-
hours, cost of fitness facilities or equipment,

and lack of flexibility in when and how long
breaks can be taken.
Poor diet may result from lack of access to
place environments.
greatest potential to disable or kill workers, so the earliest

occupational health and safety laws and codes focused
on these factors.
Hazards in the physical environment typically have the
Illnesses may remain undiagnosed and/or untreated due to lack of accessible, affordable
primary health care.
Lack of knowledge or resources for prevention of HIV/AIDS may result in high levels of
HIV infection.
Examples of ways to enhance workplace personal
health resources: These may include medical services, information, training, financial support, facilities, policy support, flexibility and promotional
programmes to enable and encourage workers
to develop healthy lifestyle practices. Some examples are:
Provide fitness facilities for workers or a financial subsidy for fitness classes or equipment.
Encourage walking and cycling in the course
of work functions by adapting workload and
processes.
Provide and subsidize healthy food choices in
cafeterias and vending machines.
Allow flexibility in timing and length of work
breaks to allow for exercise.
Put no-smoking policies in place and enforce
them.
Provide smoking cessation programmes for
employees.
Provide confidential medical services such as
health assessments, medical examinations,
medical surveillance (e.g. measuring hearing
loss, blood lead levels, HIV and tuberculosis
status testing) and medical treatment if it is

not accessible in the community (e.g. antiretroviral treatment for HIV).
Initiate health education and support activities
upon employees return to work from a work
-related illness or disability to prevent relapse
or repeat of injury.
4. Enterprise community involvement

Enterprises impact on the communities in which
they operate and are impacted by their communities. Workers' health, for instance, is profoundly affected by the physical and social environment of the broader community. Enterprise
community involvement refers to the activities in
which an enterprise might engage, or expertise
and resources it might provide, to support the
social and physical wellbeing of a community in
which it operates. This particularly includes factors affecting the physical and mental health,
safety and well-being of workers and their families.
Examples of ways enterprises may become involved
in the community: The enterprise may choose to
provide support and resources such as:
Initiating activities to control pollution emissions and clean up production operations, or
to address polluted air or water sources in
the community more generally.
Supporting community screening and treat-
care to workers and their families or supporting the establishment of primary health care
facilities in the community. These can serve
groups that do not otherwise have access, e.g.
employees of small and medium-size enterprises and informal workers.
Instituting gender equality policies within the
make a profound difference for more vulnerable sectors of the enterprise's workforce or
community's residents. In a setting where affordable health care is absent or labour and
environmental legislation weak or missing, the
enterprises community involvement may
make a world of difference to the communitys
environmental health as well as to employees
and their families quality of life.
workplace to protect and support women or

protective policies for other vulnerable
groups, even when these are not legally required.
Providing free or affordable supplemental literacy education to workers and their families.
Providing leadership and expertise related to
workplace health and safety to small and medium-size enterprises (SMEs).
Going beyond legislated standards for minimizing the enterprises carbon footprint.
Extending access to antiretroviral medications
to workers family members.
Working with community planners to build
bike paths, sidewalks, etc.
Subsidizing public transportation and bicycles
for employees to ride to work.
In a country, city or region with universal health
care and strong, well-enforced legislation related
to health, safety, pollution emissions and human
rights, enterprise initiatives in a community may
Enterprise community
involvement may make a
world of difference
to the community's
environmental health...
ment for HIV infection, tuberculosis, hepatitis

or other prevalent diseases.
Extending free or subsidized primary health
V.
The process: initiating

and sustaining a
programme
The process of developing a healthy workplace is

in many ways as critical to its success as its content. The WHO model is anchored in a wellrecognized organizational process of "continual
improvement" which ensures that a health, safety
and well-being programme meets the needs of all
concerned and is sustainable over time. The
concept (5) recognizes that any new endeavour
is unlikely to be perfect from the start. A model
of "continual improvement" for workplace health
and safety was developed in 1998 by the WHO
Regional Office for the Western Pacific. The
model has been gradually modified by experts
and agencies such as the ILO into the present
format as represented in Figure 3. Steps in the

process are described below and Section VI discusses its underlying principles.
1. Mobilize
To mobilize workers and employers to invest in
change, it is often necessary to first collect information about peoples' needs, values and priority
issues. People hold different values and operate
in differing ethical frameworks. They are motivated to action by different things by data, science, logic, human stories, conscience or religious beliefs. Knowing who the key opinion
Mobilize
Improve
Assemble
Leadership engagement
ETHICS & VALUES
Evaluate
Assess
Worker involvement
Do
Prioritize
FIGURE 3
Plan
WHO model of healthy workplace continual

improvement process
community occupational health clinic or representatives from a local industry-specific network

or a health and safety agency may be invaluable.
3. Assess
2. Assemble
Once key stakeholders have been mobilized,
they will be able to demonstrate their commitment by assembling a "healthy workplace team"
and resources to work on implementing a particular change in the workplace. If there is an
existing health and safety committee, that preexisting group may be able to take on this additional role.
In a large enterprise, the health and safety committee should include representatives from various levels and sectors of the business. These may
include health and safety professionals, human
resource personnel, engineers and any medical
personnel who provide services. The ILO recommends that in joint health and safety committees workers have at least equal representation
with employers' representatives. It is also critical
to have equitable gender representation on such
teams (6).
In a small enterprise, the involvement of experts
or support personnel from outside the organization may be helpful. For example, medical personnel from a neighbouring large enterprise or
Assessment is typically the first task the healthy

workplace team addresses, using diverse tools
and measures such as:
Baseline data on workplace inspections, prior
hazard identification and risk assessment processes, health and safety committee minutes, employee demographics, turnover and productivity
statistics, union grievances (if applicable). All
these should be documented if available. If a
comprehensive hazard identification and risk assessment has not been done, it should be done
at this time. Current policies or practices relating to the four avenues of influence should be
reviewed and tabulated.
Workers health is another critical factor to assess
in terms of occupational health data, such as
rates of sick leave and workplace-related injuries
and illnesses, including short- and long-term disabilities. The other essential aspect is the personal health status of employees. This information may be obtained via a confidential survey, or
in smaller business settings, a walk-through with
a checklist and/or dialogue between the manager,
workers and ideally a health professional.
The desired future for the enterprise and workers
leaders and influencers are in an enterprise and

what issues are likely to mobilize them will be
critical to building commitment around an action
or initiative.
OPPOSITE
Building construction in Chicago, USA, 1987 ILO
must also be assessed. For a large corporation,

this may involve some benchmarking exercises to
determine how similar companies are doing with
respect to the data just described. It may be important to do a literature review to read recommendations or case studies of good practice. For
individual workers, it is necessary to ask their
ideas about how they would seek to improve
their working environment and health, and what
they think the employer could do to assist them.
wins that may motivate and encourage continued progress;

Risk to workers (severity of exposure to a
For a small enterprise, determining local good

practice is important. Talking to local experts or
visiting local enterprises that have addressed
similar situations is a good way to find out what
can be done and get ideas on how to do it.
problem;
The subjective opinions and preferences of
Whatever methods are used to collect this information, it is important to make sure that women
have as much opportunity for input as men, and
that their issues can be disaggregated.
4. Prioritize
Priority-setting criteria should take diverse factors into consideration while recognizing that
some priorities are more directly essential to
health, such as limiting exposure to occupational
hazards. Other criteria that may be considered
are:
Ease of implementing solutions, such as quick
hazard and probability that exposure will occur);

Possibility of making a difference, e.g. existence of effective solutions, employer readiness to change, likelihood of success and
other issues related to workplace policies or
politics;
The likely costs of ignoring or neglecting the
the workplace parties, including managers,

workers and their representatives.
5. Plan
The next step is to develop a health plan. The
plan developed by a small or medium-size enterprise, at least initially, might be quite simple, depending on the enterprises size and complexity.
It may focus on a few of the priorities identified
as most critical to health, as well as goals most
readily attainable, with an indication of time
frames.
In a large enterprise, a plan could take a much
more complex, big picture approach to the
next 3-5 years. This kind of plan would set out
general activities to address priority problems
with broad time frames. The overall plan should
important.Talking to local experts or visiting enterprises

that have addressed similar situations is a good way to
find out what can be done and get ideas on how to do it.
For a small enterprise, determining local good practice is
BELOW
Lady with sewing machine, Republic of Korea, 2008. Photographer: Suvi Lehtinen, Finland. Developing healthy workplaces in the informal economic sector is a global challenge
that needs to be faced.
have some long-term goals and objectives set in

order to measure success. After developing the
long-term plan, annual plans would be developed
to address issues in order of priority.
When considering solutions, it is important to
remember the learn from others principle and
to research ways of solving problems. It also is
important at this point to remember the four
avenues of influence when developing solutions.
For example, a common mistake is to think that
solutions for problems in the physical work environment must always be physical solutions,
when, for instance, training or behaviour change
might also address the issue.
plan, it is time to develop specific action plans

that spell out goals, expected outcomes, time
lines and responsibilities. For health education
programmes, it is important to go beyond raising
awareness to include skill development and behaviour change. The required budgets, facilities
and resources should be included, as well as
planning for launching, marketing and promoting
the programme or policy, training for any new
policy, maintenance and evaluation plan. Ensuring
that each point in a plan or an initiative has
clearly stated, measurable goals and objectives
will make evaluation easier.
After obtaining any required approvals for the
6. Do
7. Evaluate
Evaluation is essential to see what is working and
what is not, and to determine why or why not.
Both the implementation process and outcomes
should be evaluated in the short and long terms.
In addition to evaluating each initiative, it is important to evaluate the healthy workplace programmes overall success after 3-5 years, or after
a significant change such as new management.
Sometimes repeating a survey or reviewing the
kinds of data collected as a baseline can provide
this overall assessment. While it is unlikely that
the changes to worker health will be able to be
causally linked to changes in enterprise productivity or profitability, it is important to track
these numbers and compare them to benchmarks.
While all enterprises have different needs and
Leadership engagement
ETHICS & VALUES
Worker involvement
8. Improve
This last step is also the first in the next cycle of
actions. This involves making changes based on
evaluation results. These changes can improve
the programmes that have been implemented, or
add on the next components. On the other
FIGURE 4
Underlying principles - keys to success
This is the just do it stage. Responsibilities for

each planned action should be assigned to various actors within the implementation team and
follow-up should be ensured.
hand, some notable successes may have been

achieved. It is important to recognize successes,
to appreciate the people who participated in
achieving the successful outcome and to make
sure that all stakeholders are aware of the
achievement.
VI.
Underlying principles:
keys to success
situations, there are some key underlying principles of a healthy workplace initiative that will
raise its likelihood of success. Figure 4 refers.
1. Leadership engagement based on core

values
This hinges on three factors. The first is mobilizing and gaining commitment from major stakeholders, because a healthy workplace programme must be integrated into the enterprises
business goals and values. Another must is getting necessary permissions, resources and support from owners, senior managers, union leaders or informal leaders. It is critical to get that
commitment and buy-in before trying to proceed. The third factor is providing key evidence
of this commitment by developing and adopting a
comprehensive policy that is signed by the enterprises highest authority and communicated to all
workers. This clearly indicates that healthy workplace initiatives are part of the organizations
business strategy.
2. Involve workers and their representatives

One of the most consistent findings of effectiveness research is that in successful programmes
the workers affected must be involved in every
step of the process from planning to evaluation.
Workers and their representatives must not sim-
ply be consulted or informed about what is

happening but must be actively involved, with
their opinions and ideas sought out, listened to
and implemented.
Due to the inherent dynamics of relations between labour and management, it is critical that
workers have some collective means of expression, stronger than that of individual workers.
Participation in trade unions or representation
by regional worker representatives can help provide this voice.
3. Gap analysis
This involves assessment of "what is the situation
now?" as compared with what ideal conditions
would be, and then dealing with gaps between
the two.
4. Learn from others

It is important to acknowledge that not everyone, including workplace health and safety officials, has the knowledge and tools to address
certain priority issues. In such cases, it is important to call upon other experts, e.g. researchers
from a local university or experts in a local safety
agency. Union representatives who have received
special occupational safety and health training
and occupational health and safety experts in
larger enterprises in the community may also be
BELOW
Office of home appliance company, Hangzhou, China ILO
recruited. These experts can mentor and assist

smaller enterprises. Visiting other enterprises to
observe local good practice is another excellent
way to learn from others. Additionally, the virtual world contains a wealth of resources and
information, including the websites of ILO,
WHO and its Collaborating Centres for Occupational Health and Safety.
Evaluation and continuous improvement are key,

as is ensuring that healthy workplace initiatives
are integrated into the enterprises overall strategic business plan rather than existing in a separate isolated work group.
In larger organizations, work is increasingly specialized. Similarly, in many large organizations,

health and safety personnel work in one department, wellness professionals in another and human resource professionals in yet other departments. The latter group deals with many issues
related to leadership, staff development and the
psychosocial work environment. All of these departments are separate from the enterprises
management team, which is focused on increased
output quality and quantity. Often these activities
will work at cross purposes or in direct opposition to worker health, even though the healthy
workers are as critical as other aspects of production and quality.
6. The Importance of integration
How can integration be assured? Here are a few
5. Sustainability
examples:
Strategic planning must incorporate the human side of the equation. Kaplan and Norton
in 1992 developed a balanced scorecard
approach to management and integrated management systems (7). It points out the desirability of measuring not only financial performance but also customer knowledge, internal business processes and employees
learning and growth to develop long-term
business success.
Develop and gain senior management acceptance and use of a health, safety and wellbeing filter for all decisions.
Keep the various components of a healthy
workplace in mind whenever a problem is
being addressed. For example, if musculoskeletal disorders were occurring among
people who work all day at sewing machines,
a common (and appropriate) approach would
be to examine the ergonomics of the operators in their work stations, and to fix any hazardous physical conditions. However, additional contributors to the problem might be
psychosocial issues such as workload and time
pressure. And there may be personal health
issues related to physical fitness and obesity
that are contributing to the problem. Or a
lack of primary health care resources in the
community may mean workers cannot be assessed and treated in the early stages of pain.
An integrated approach would examine all
aspects of the problem and thus identify a

wider range of effective solutions.
Behaviour that is rewarded is reinforced. A
performance management system that rewards high output, regardless of how the results are achieved, will encourage people to
take shortcuts or to use less-than-healthy
interpersonal skills to get work done. On the
other hand, a performance management system that sets behavioural standards as well as
output targets can reinforce the desired behaviours and recognize people who demonstrate behaviours and attitudes that lead to a
healthy workplace culture.
Use of cross-functional teams or matrices can
help reduce isolation of work groups. If an
organization has a health and safety committee and a workplace wellness committee, they
could avoid working in isolation by having
cross-membership, so that each is aware of
and able to participate in the others activities.
The healthy workplace model set forth here
VII.
represents a synthesis of best available knowledge and experiences worldwide, as collected

and analyzed by occupational health experts in
diverse countries.
It provides guidance for action at the workplace
level, particularly when the employer, workers
and their representatives work together in a collaborative manner. However, workplaces exist in
a much larger context. Governments, national
and regional laws and standards, civil society,
market conditions and primary health care systems all have a tremendous impact on workplaces, for better or for worse, and on what can
be achieved by workplace parties.
These interrelationships are extremely complex,
and are expanded upon in the Healthy workplaces
background document cited in page 3. Guidance
and procedures are also needed to engage diverse actors directly in healthy workplaces initiatives. In terms of advancing workplace health,
developing and developed countries have very
different needs and challenges, as do smaller and
larger enterprises. The Background document also
includes examples of how this model might be
implemented in large and small enterprises, and
case studies of what works and what doesnt
work in diverse situations. Links and resources
provided there can help employers, workers,
policy-makers and practitioners adapt these principles to their specific situations. Additionally, as
implementation of the WHO Global Plan of Action
advances, the WHO and its Member States, collaborating centres and other experts will provide
more targeted and practical guidance. This will
guide enterprises, employers and workers, in
applying principles of this framework to different
cultures, sectors, and workplaces, in adherence
with the principles of continuing improvement of
interventions.
...developing and
developed countries have
very different needs and
challenges, as do smaller
and larger enterprises.
Adapting to local
contexts and needs
References
(1) ILO, Facts on safety at work. April 2005.
Useful links:
(2) ILO/WHO joint press release. Number of

work-related accidents and illnesses continues to
increase: ILO and WHO join in call for prevention strategies. 28 April 2005.
WHO Occupational Health homepage: www.who.int/occupational_health
(3) Prss-Ustn A, Corvalan C. Preventing disease through health environments: towards an

estimate of the environmental burden of disease.
Geneva: WHO, 2006.
(4) http://www.issa.int/aiss/content/
download/43103/824949/
file/2Seoul_Declaration.pdf
(5) The concept of continual improvement was
first popularized in the 1950s by social scientists
such as Edward Deming, who developed the
Plan, Do, Check, Act (PCDA) model. This, in
turn, was inspired by the scientific method of
hypothesize, experiment, evaluate.
(6) Recommendation 164 to Convention 155 on
Occupational Safety and Health, 1981Review 82
(2): 52-63.
(7) Kaplan RS, Norton DP. "The balanced scorecard: measures that drive performance." Harvard
Business Review 82(2): 52-63.
WHO Healthy Workplaces homepage: http://

www.who.int/occupational_health/
healthy_workplaces/en/index.html
WHO Collaborating Centres: http://
www.who.int/occupational_health/network/en/
ILO website: www.ilo.org
WHO healthy workplaces background document:
http://www.who.int/occupational_health/
healthy_workplaces/en/index.html.
Lead author:
Joan Burton, BSc, RN, MEd, strategy advisor for the
Industrial Accident Prevention Association, Canada.
The photos on the cover page, and on pages 2 and 3,
were winning entries in a first-ever photographic
competition on the theme, Healthy workplaces, my
work, my health, sponsored by the WHO Regional
Office for the Americas/Pan American Health Organization (PAHO) in 2010.
Project working group:
Evelyn Kortum, Global project coordinator, Department of Public Health and Environment, World
Health Organization, Geneva, Switzerland
PK Abeytunga, Canadian Centre for Occupational
Health & Safety, Canada
Fernando Coelho, Servio Social da Indstria, Brazil
Aditya Jain, Institute of Work, Health and Organisations, United Kingdom
Marie Claude Lavoie, World Health Organization,
AMRO, USA
Stavroula Leka, Institute of Work, Health and Organisations, United Kingdom
Manisha Pahwa, World Health Organization, AMRO,
USA
Peer reviewers:
Said Arnaout, WHO Regional Office for the Eastern
Mediterranean Region (EMRO), Cairo, Egypt
Janet Asherson, International Employers Organization,
Switzerland
Linn I. V. Bergh, Industrial Occupational Hygiene Association, and Statoil, Norway
Joanne Crawford, Institute of Occupational Medicine,
UK
Reuben Escorpizo, Swiss Paraplegic Research (SPF),
Switzerland
Marilyn Fingerhut, National Institute for Occupational

Safety & Health, USA
Fintan Hurley, Institute of Occupational Medicine, UK
Alice Grainger Gasser, World Heart Federation, Switzerland
Nedra Joseph, National Institute for Occupational
Wolf Kirsten, International Health Consulting, Germany
Rob Grndemann, TNO, The Netherlands
Kazutaka Kogi, International Commission on Occupational Health
Ludmilla Koen, National Institute of Public Health,
Czech Republic
Wendy Macdonald, Centre for Ergonomics & Human
Factors, Faculty of Health Sciences, La Trobe University, Australia
Kiwekete Hope Mugagga, Transnet Freight Rail, South
Africa
Buhara nal, Ministry of Labour and Social Security,
Occupational Health and Safety Institute,Turkey
Teri Palmero, National Institute for Occupational
Zinta Podneice, European Agency for Safety and
Health at Work, Spain
Stephanie Pratt, National Institute for Occupational
Safety and Health, USA
Stephanie Premji, CINBIOSE, Universit du Qubec
Montral, Canada
David Rees, National Institute of Occupational Health,
South Africa
Paul Schulte, National Institute of Occupational Safety
& Health, USA
Tom Shakespeare, Disability Task Force, World
Health Organization, Geneva, Switzerland
Cathy Walker, Canadian Auto Workers
(retired),Canada
Matti Ylikoski, Finnish Institute of Occupational
Health, Finland
Acknowledgements
Healthy Workplaces:
a model for action
For employers, workers, policy-makers
and practitioners
Workers health, safety and well-being are vital

concerns to hundreds of millions of working
people worldwide. However, the issue extends
even beyond individuals and their families. It is of
paramount importance to the productivity, competitiveness and sustainability of enterprises,
communities, and to national and regional economies.
Currently, an estimated two million people die
each year as a result of occupational accidents
and work-related illnesses or injuries. Another
268 million non-fatal workplace accidents, as well
as 160 million new cases of work-related illness,
occur each year. Additionally, 8% of the global
burden of disease from depression is currently
attributed to occupational risks.
This document proposes a global framework for
planning, delivery, and evaluation of essential interventions for workplace health protection and
promotion.
Dr Maria Neira
Director
Department of Public Health and Environment
www.who.int/occupational_health/
20, Avenue Appia
CH1211 Geneva 27
T: +41 22 791 2111
F: +41 22 791 3111
www.who.int
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Through its member-led working groups and executive leadership, IPIECA brings together the collective
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E-mail: info@ipieca.org Internet: www.ipieca.org
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Prevention of heart

attacks and other

International Association of Oil & Gas Producers

OGP Report Number 491

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PREVENTION OF HEART ATTACKS AND OTHER CARDIOVASCULAR DISEASES

What is a heart attack?

Symptoms of a heart attack

How sleep affects you heart

The brain and strokes

Practical behavioural changes

What can the oil and gas industry do?

Hypertension (abnormally high

What is blood pressure?

Normal blood pressure

How stress affects the heart

Interpreting the BP readings

Warning signs of stress

When to treat hypertension

Employees role in stress reduction

What can the oil and gas industry do?

The ageing workforce and

Smoking and cardiovascular disease

Characteristics of the older workforce

Smoking and respiratory disease

Smoking and cancer

Other adverse health effects

What oil and gas companies can do to

Smoking in the workplace

Why should companies address the issue?

What can companies do?

Cholesterol and triglycerides

Elevated blood sugar levels

What can the oil and gas industry do?

Health impacts of physical inactivity

How much physical activity do we need?

Risks and benefits of physical activity

Psychosocial origins of the epidemic

Obesity and the oil and gas workforce

What can the oil and gas industry do?

Nutrition and diet

Nutrition and cardiovascular disease

What can the oil and gas industry do?

Appendix 2H-Factor Programme

Appendix 3Healthy workplaces: a model

PREVENTION OF HEART ATTACKS AND OTHER CARDIOVASCULAR DISEASES

Raising understanding and awareness of

The main causes of CVD include:

Oil and gas industry responses to the risk

smoking prevention and reduction, healthier

The work location is often the first place where

PREVENTION OF HEART ATTACKS AND OTHER CARDIOVASCULAR DISEASES

Figure 1 The human heart

right coronary artery

inferior vena cava

onus of prevention and treatment rests on the

What is a heart attack?

Above: the heart is a

This condition commonly occurs in men over 40

Figure 2 Causes of a heart attack

1. Atherosclerosisthe artery is clogged

2. Blood clotprone to developing in

spreads to the neck, back, jaw, shoulders or