Occupational health problems may not cause fatal injuries as in the case of general physical injuries on a construction site. Yet, there are far more occupational health injuries than serious physical injuries. Although some problems may be fairly mild, occupational health hazards have a long latency period and what may be a small problem in the short term could prove fatal in the longer term, particularly something like asbestos inhalation. Lung cancer can develop as a result of exposure to such a toxic substance. This article seeks to expose the extent of occupational health problems and suggests how improvements can be made to reduce such occurrences. These include the preparation of health and safety plans for construction work and minimising workplace stress.

Learning objectives

  1. Understand the nature and problem of occupational health.
  2. Be able to differentiate between occupational health problems and general physical injuries (i.e. their type and latency period).
  3. Be able to explain the various causes of stress in the construction workplace.
  4. Appreciate how a project manager can contribute to the reduction of stress in the workplace.
  5. Understand who should put together a health and safety plan and at what point during the lifecycle of a construction project.
  6. Be able to apply occupational health measures appropriately for a design project of your own, drawing on ideas and values explained in the article.


Construction is a high-risk sector for accidents in the workplace, accounting for a third of all work-related fatalities in the UK for example. Around 2,000 workers have been killed in the last 25 years. Despite targets set by the sector to improve safety standards many workers are killed each year at work. Although incidence rates are in decline - in part because of the reduction of construction activity in many countries - it is little comfort to the families of the many workers killed each year. There is also the long-term and potentially lethal health risks that many workers take every day when out on site. It is important to examine the long-term problems that workers are exposed to and which are being ignored by some organisations. These cover, for example, asbestos poisoning and irreversible damage such as noise-induced hearing loss. Serious accidents are highlighted by official statistics, yet there are manifold victims of occupational illness that go unreported in this way. Work accidents such as severed limbs and broken bones are easily identifiable and figure importantly in the press, but health matters which are potentially just as severe attract little in the way of coverage. The gross under-reporting of occupational illnesses is mostly due to a long latency period. It is difficult to identify an occupational illness as it can take, in the most extreme cases, perhaps up to 30 years to manifest symptoms from exposure to toxic substances.

An engineer working on an old building was consistently being exposed to asbestos and eventually contracted terminal lung cancer. It was a slow killer. Depending on the country, many thousands more people suffer the same fate each year. There are other potential health risks and these can include cement dermatitis, tinnitus, hearing loss, hand-arm vibration syndrome (HAVS) and, particularly, musculo-skeletal disorders such as bad backs and sprains.

This unit seeks to expose the extent of the most common occupational health problems in construction today and looks at ways to plan and put into practice means and measures for helping to reduce them.

Occupational health

It is important to understand occupational health problems in order to get them into perspective and realise the potential risks that you and your colleagues may be putting yourselves through if you do not possess a watertight occupational health policy. First, we need to realise what occupational health is and how it relates particularly to the construction sector.

The term occupational health is a blanket phrase that encompasses a variety of problems. It can include minor injuries, such as a cut finger and can be as severe as a long-term back problem caused by lifting heavy objects. The worst casualty statistic for musculo-skeletal disorders is found in the construction sector which is unsurprising when the nature of the work is considered. It also tops the list in the sector as the most common health risk with a reported one quarter of all incidents being of a musculo-skeletal nature. Of those incidents, around one third are for a period of more than three days and are contributing significantly to an absence from work of those who suffer such complaints. In fact, of those workers, the UK's Health & Safety Executive (HSE) has reported that they take an average of 11 days off work - a significant absence. This emphasises the importance of dealing with such problems straight away. Any damage in the short-term can grow worse and become potentially disabling if the worker then carries on doing a similar task.

One problem that gives rise to more thousands of cases annually is a phenomenon called hand-arm vibration syndrome (HAVS), a form of Raynaud's Disease. This condition is usually brought on by the use of power tools such as breakers and hammer drills. When hands are exposed to vibrating equipment (the most common being vibration white finger), the person's blood circulation is affected. Vibration white finger is so-called because the fingertips turn white and numb when cold and wet. When circulation does return, the hand will be red and painful. Longer term damage can result and the whole finger can be affected if there is constant exposure to vibration.

The European Union (EU) has taken steps to limit the substance responsible for cement dermatitis. This is a skin complaint caused by exposure to wet concrete or mortar and the workers most at risk are therefore plasterers, bricklayers and concrete layers. Symptoms consist of itchy and sore skin which can become red and cracked. There are, in fact, two variants of the condition, irritant dermatitis and allergic dermatitis, of which the latter variant has caused 10% of affected construction workers to leave the sector. This variant is caused by chromates contained in the cement which sensitise the skin. Hopefully, an EU directive limiting the amount of free chromates in cement will reduce significantly the number of workers having to leave the sector due to allergic dermatitis. The problem continues to remain hidden below the surface, though the EU is going some way to improving working conditions. 

The hazard that continues to top the list is the killer substance, asbestos. In the US alone, it has been estimated that at least 1.3 million employees in construction and general industry faced significant exposure to asbestos over the past decade. Exposure is particularly prominent during the removal of the substance in renovation and demolition. The activity of demolishing buildings, in itself, is high-risk. In the UK, asbestos-related lung cancer has continued to rise to around 10,000 deaths in 2010. The problem is likely to continue because there are thousands of tonnes of asbestos still present in over half a million non-domestic buildings. Asbestos was used extensively from the 1950s until the mid-1980s. 

Taking care on site

As it stands, occupational health problems are a cause for considerable concern by contractors. It therefore makes sense to undertake measures to introduce occupational health improvement schemes on site. Time and therefore money is saved with the presence of medically-trained personnel on-site. A quick diagnosis of an injury can be made and appropriate action taken. This, of course, refers to minor injuries and is more practical to implement on major sites.

 Many large sites also offer a screening service to workers for problems such as cholesterol and diabetes. Other services included counselling; if a drama is made out of a cut finger it is possible that the worker has underlying emotional problems. It is therefore important to have someone close at hand whom the workers can trust and feel they can talk to, because there are times when occupational health problems are not merely physical, but psychological too. It is important to gain the workers' acceptance of screening services which they may view with suspicion, thinking that they may be used to screen for illegal substances and alcohol.

Health check-up

A decade or so ago, health in the workplace was taken lightly in many places, so there has been a major step forward since then if the presence of occupational health schemes within organisations is anything to go by. The following approach is useful when considering the presence of toxic substances and the risk that construction work can pose to health during a project.

The international construction company, Skanska, has adopted a particular approach. An occupational health nurse or agency nurses are permanently stationed on larger sites. The nurses' roles are to identify occupational health risks, seek out ways of reducing them, carry out screening, offer dietary advice and deal with minor injuries.

For workers in some industrial sectors and those in construction working on high-risk sites these practices, and more, may already be the norm. What is needed is for the rest of the construction sector to bring itself up to the level of modern industry and the practices routinely applied there. Much of construction remains outside the strict controls and higher standards of safety awareness practised in other industries such as manufacturing and petrochemicals. It does not need the brain of Einstein to realise that construction lags and must raise its standards. The only site is a safe site.

Stress at work

Stress, like a square, has four sides to it:

  1. physical - symptoms such as medical problems, e.g. headaches.
  2. behavioural - mental symptoms that can also manifest into physical conditions, e.g. eating disorders.
  3. psychological - mental symptoms, e.g. depression.
  4. organisational - the response to the work environment, e.g. absenteeism.

It is believed that in the UK alone, 40 million working days and £7bn are lost each year because of stress. It is the responsibility of managers to safeguard the health of their employees, with such actions being seen as an investment. There are many reasons for stress existing in the workplace and in society. The main perpetrators seem to be problems of dealing with work diversity, technological innovation and ethical factors. Frustration, which can be seen to be a symptom of stress, has formally been recognised as being caused by external factors such as those mentioned above. Yet, it is a condition that originates internally, or in other words, from the people themselves. For example, people may overestimate their skill or underestimate their potential. Actions that can be taken to deal with stress include:

  1. recognising the symptoms of stress
  2. finding the sources of pressure
  3. identifying coping strategies.

It is, however, necessary to bear in mind that a degree of frustration can be good and articulated to push you in the direction needed to achieve your objectives.

  • It can strengthen the effort required to achieve the objective.
  • People can find a different way of achieving their objective.
  • Another objective can be attempted if the one set is unrealistic or not useful to the overall effort of the project.

A further reason why managers should take the necessary steps to help reduce workplace stress is because occupational health has been found to be closely associated with organisational effectiveness. Another way of putting it would be to say that how the organisation is run forms part of the levels of stress experienced at work. The UK's CIPD (Chartered Institute of Personnel and Development) has much to say on this issue:

  • people work more effectively with a participative management style
  • people are better motivated when work satisfies economic, social and psychological needs
  • motivation improves if attention is paid to the job design and work organisation.

The very fact that employees suffer higher levels of stress in contrast to their managers should be seen as a red light to employers to do all that they can to reduce levels of stress for those they manage. Employers should be able to monitor and control the known causes of stress which are:

  • autocratic and erratic management
  • ineffective communication processes
  • overwork
  • lack of control over work practices. 

Managing health and safety during construction

The following guidelines are applicable to managing health and safety during the construction phase. For a comprehensive treatment of the responsibilities and duties facing owners, designers and constructors, see The Construction (Design and Management) Regulations 2007 - similar legislation exists in other countries. 

  1. Ensure that a detailed health and safety plan (H&S plan) has been prepared by the principle contractor and circulated before commencing work.
  2. The H&S plan, whilst not including all information at the start of the construction phase, must be sufficiently developed so that:
    • the general framework is there for dealing with the management organisation, emergency procedures, monitoring arrangements, communications and welfare;
    • the plan addresses the key tasks of the early work stages.
  3. Clients would be well advised to seek professional advice about the suitability of their H&S plan. It is the legal duty of the planning supervisor to provide advice if requested and to ensure designers comply with their duties and prepare the health and safety file.
  4. The designer must identify health and safety hazards and risks of ongoing design work. They must also engineer a hierarchy of risk control which consists of, first, evaluating whether or not the risk can be avoided. If not, it is tackled at its source. If this fails to work, measures must be used to control the risk for all workers and for workers' personal protection.
  5. The designer must also provide satisfactory information about health and safety to those who require it. 


Occupational health hazards are a great cause for concern perhaps not only because of their alarming frequency, but also over concern about the size of the problem and the best ways of tackling it. This article has helped identify some of the most common occupational health problems in construction today and looked at ways to plan and put into practice means and measures for helping to reduce potential problems.

It is important for managers to identify when their employees are suffering from occupational health problems, including stress, and make sure that they are managing co-workers effectively so as to keep problems to a minimum. In the particular case of stress, there will inevitably be an element of it in the workplace, but it needs to be a productive force as opposed to being destructive.


  1. Identify possible occupational health hazards on any current construction site and rate their level of risk.
  1. How would you deal with the potential risks that you have identified? At what stage of the design/construction process would you organise measures to combat potential occupational health risks?
  1. Identify a period when there has been a high degree of frustration and/or stress and the reasons for it.
  1. Explain how you deal with the frustration and/or stress and its effect on consequent work conditions.
  1. Choose a probable cause of stress, some of which have been listed above, and show how it can contribute to stress in the work environment.

References and bibliography

UK, The Construction (Design and Management) Regulations 2007. London: Staionery Office (available at: http://www.legislation.gov.uk/uksi/2007/320/pdfs/uksi_20070320_en.pdf).

Ridley, J. (2008) Health and safety in brief. 4th edn. Oxford: Butterworth-Heinemann.

St. John Holt, A. (2005) Principles of construction safety, Oxford: Blackwell.

Other useful sources of information:

http://www.hse.gov.uk/statistics/causdis/asbestos.htm : UK Health & Safety Executive website section on asbestos related disease.

http://www.osha.gov/SLTC/asbestos US Department of Labor website section on asbestos.

http://www.cipd.co.uk/subjects/health/stress/stress.htm Chartered Institute of Personnel and Development web-based factsheet giving introductory guidance on stress.

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