Twenty-year look-back by former IWH president finds bright spots in prevention system

Lecture by Dr. Cameron Mustard highlights employer investment, labour advocacy, system improvement, and stakeholders’ use of research evidence

Published: December 21, 2022

As he looked back on 20 years as president of the Institute for Work & Health (IWH), Dr. Cameron Mustard repeatedly marvelled at the “bold” and “imaginative” decision in the late 1980s to establish the Institute to begin with.

He gave credit to the late Robert (Bob) Elgie, a Progressive Conservative former minister of labour who also chaired what was then known as the Workers’ Compensation Board (1985 to 1991). ‘Let’s establish an independent research organization funded by workers’ compensation premiums, with a mandate to support WCB policy developments.’ These things don’t happen very often, said Mustard at the Alf Nachemson Memorial Lecture, an event attended by 100 people in downtown Toronto on November 5, 2022.

The lecture, hosted annually by IWH until its recent three-year hiatus, was particularly meaningful this year. It gave many in Ontario’s OHS research and prevention system their first chance to gather since the pandemic. It was also an occasion for Mustard, who retired in January 2022, to pull together the key through-lines in work and health research that he observed during his tenure.

Although Mustard’s lecture was structured around five themes, a sixth, unnamed theme also emerged. It was that of the Institute’s special role as an independent and impartial research centre driven to answer questions that are important to workers, employers and policy-makers.

‘Independent’ means that it’s our job and our job alone to decide how to use research methods to address a specific question. ‘Impartial’ means we don’t have loyalty to a particular stakeholder perspective, said Mustard. And it means we don’t advocate for a policy direction or option. We try to provide information that helps narrow some of the differences that people might have about what the policy options should be.

Mustard noted that, 30 years after its founding, the Institute remains one of only three research organizations in North America of similar stature and focus: IWH, the Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRRST) in Quebec, and the National Institute for Occupational Safety and Health (NIOSH), an arm of the U.S. Centers for Disease Control.

“It is amazing to me that there are 175 million workers in North America, and there are only three research organizations that are focused on what the Institute’s focused on,” said Mustard. [That’s] one reason I did [this job] for as long as I did: the work is really important. The opportunity to be at the Institute is a unique responsibility. And I realized I had a personal commitment to see Bob's vision succeed.

Five themes

Mustard reflected on key developments in occupational health and safety (OHS), particularly in Ontario, during his time at the Institute. He listed the five following themes:

1. A substantial reduction in work-related injury or illness has occurred over the past 20 years in Ontario. Mustard pointed to data from three sources to back up this conclusion. The frequency of workers’ compensation claims (combining those that involved lost time and claims that involved medical care but no time away from the job) declined by almost 50 per cent over the period 2000-2019. This corresponds to 200,000 fewer claims in 2019 than would have occurred had the 2000 claim frequency been sustained.

Another source of pertinent data is Statistics Canada’s Canadian Community Health Survey, which includes a question on self-reported incidence of medically-attended injuries among adults aged 15-64 by occupational and non-occupational causes. An IWH research team that included Mustard looked at the data for Ontario from the 2001 and 2010 surveys. It found that the frequency of occupational injuries per person-year declined by an average of 7.4 per cent per year over this period, while the frequency of non-occupational injuries rose by an average of 1.0 per cent per year.

The third source of data is emergency department records. The same IWH team looked at these records for Ontario over the period 2004-2011. Injuries reported as occupational declined by an average of 5.95 per cent per year, while non-occupational injuries declined by only 0.25 per cent per year.

2. Employer expenditures on OHS are substantial. A study team that Mustard led recruited Ontario employers with 20 or more employees from 17 economic sectors. Data were obtained from 334 companies on OHS expenditures in five dimensions: organizational management and supervision (which relates to time spent on OHS matters), staff training in health and safety, personal protective equipment, OHS professional services, and the share of new capital investment attributed to OHS. The overall average expenditure was estimated at $1,303 per worker per year in 2017. A prominent factor contributing to the reduction in work-related injury and illness may be the scale of employer expenditures on OHS, suggested Mustard.

3. Organized labour has been a powerful driver of positive change in OHS. In Ontario, organized labour played a prominent role in three key reform processes in recent years: the Expert Advisory Panel on OHS that reported to the Minister of Labour in 2010; the Mining Health, Safety and Prevention Review, which reported in 2015; and the Workplace Violence Prevention in Health Care Leadership Table, which reported in 2017.

The efforts of organized labour were also instrumental in the development of Bill 168, which, in 2010, amended the Occupational Health and Safety Act to require employers to have policies and programs in place to address workplace violence and harassment. This was the result of advocacy by organized labour, at a time when many—including researchers at IWH—did not fully understand the magnitude of the problem, said Mustard.  

Nearly 10 years later, the International Labour Organization adopted a convention on eliminating violence and harassment in the world of work. This wouldn't have happened, in my view, if the ILO didn't have access to the regulatory precedence that were established in this country a good eight or nine years before the ILO wrapped their arms around the issue, he added.

4. OHS regulatory standards and enforcement are effective. “Over the last 20 years, there’s been far too much controversy about this point,” said Mustard, as he launched into several studies—examples of how excellent research over the last 20 years has helped reduce the amount of controversy about this statement.<.q>

Among the evidence that Mustard cited were two IWH studies. One was research led by IWH Scientist Dr. Lynda Robson, which found that an Ontario regulatory training standard for construction workers using fall protection equipment led to a substantial (almost 20 per cent) reduction in the rate of lost-time injuries attributed to falls when working at heights.

The second was a systematic review of the research on the effectiveness of OHS enforcement interventions. Led by IWH Senior Scientist Dr. Emile Tompa, it found that inspections that result in a citation or penalty reduce work-related injuries. The Tompa study influenced a decision by the U.S. Occupational Safety and Health Administration to strengthen its enforcement practices.

5. Research has contributed to innovation and reform at the Ontario Workplace Safety and Insurance Board (WSIB). A key example was the development of the New Service Delivery Model in 2008-09, which led to marked improvements in returning injured workers to work. This included a new case management framework, the introduction of return-to-work specialists, and an emphasis on timely first decisions on workers’ compensation claims. Mustard noted that Judy Geary, who was the WSIB’s vice-president of program development at the time, acknowledged that advice from IWH researchers contributed to the design of the new initiatives.

Mustard also noted work led by Tompa that examined the long-term income trajectories of injured workers. The study found that, once benefits provided by the WSIB to injured workers with permanent impairments were factored in, the proportion of injured workers who earned less than half of what they might have expected to earn fell from 40 per cent to 13 per cent. And on average, among injured workers who have permanent impairments, the combination of labour market earnings plus permanent impairment benefits was a 104 per cent of the average earnings of workers who were not injured. q>Because we can’t make people whole, at least we can try to address some of the financial consequences of the impairment, said Mustard.

To listen to the lecture, go to: