A Call for Leading Health Metrics

Good management requires metrics, but some metrics are better than others. Metrics as performance indicators come in two general types: lagging and leading indicators. Lagging indicators are measures of outcome, such as injury statistics, production numbers, or profit figures. They are important bottom line measures, but they can be poor management tools because they only tell you what has already happened. Leading indicators, on the other hand, can be predictive, and can often be used for prevention or performance shaping. Take heart disease and high cholesterol, for example. Heart disease is an outcome, so it is a lagging indicator, but cholesterol level could be a leading indicator, since high levels can predict future heart disease; cholesterol level thus may be a useful tool for evaluating prevention efforts.

When it comes to workplace safety, many, including the National Safety Council, have made a concerted effort to supplement traditional lagging indicators, such as OSHA injury and illness rates, with leading safety performance indicators. Some progress is being made in a new ANSI standards committee (ANSI Z16 -Leading/Lagging Indicators), which is developing a balanced scorecard approach to safety and health performance measurement using a combination of lagging, leading, and value (cost) metrics. ANSI Z16 is a voluntary consensus safety standard, designed to reflect industry best practices. Although not enforceable, the standard would be formally recognized by ANSI and/or ISO.

Occupational health metrics are a greater challenge than safety metrics, especially for lagging indicators. Injuries such as broken bones and cuts, for example, are relatively easy to count (although questions of interpretation around work relationship and severity criteria may still exist). Occupational illness, on the other hand, is more difficult to measure for several reasons. Many occupational diseases, such as hearing loss or asthma, may have mixed occupational and non-occupational origins, or may be confounded by personal factors (e.g., smoking). In addition, a latency period often occurs in disease development and recognition, making pinpointing a work relationship difficult, especially if the condition develops after the worker has changed employment.

That is one reason why the current NIOSH emphasis on total worker health makes sense. Launched in 2011, “Total Worker HealthTM is a strategy integrating occupational safety and health protection with health promotion to prevent worker injury and illness and to advance health and well-being” (Schill, 2013). In many companies, medical, safety, industrial hygiene, disability, employee assistance, health promotion, and workers’ compensation often operate in independent silos. Total Worker HealthTM aims instead to provide a unifying purpose: to protect and promote the total health, safety, and well-being of workers. This emphasis on prevention requires a focus on precursors of both good and poor health. Leading indicators of health may be more useful and reliable measures of progress than lagging metrics.

The American Industrial Hygiene Association (AIHA) has recently approved an initiative to gather information on leading health indicators. This effort is being led by Alan Leibowitz, and is attempting to catalog leading health indicators already successfully in use. If you have ideas about, or experience with, health metrics to share, you can contact either Alan Leibowitz at: alanleibowitz.ehs@gmail.com, or other committee members, including Tom Slavin at: tom.slavin@cardno.com. Additionally, Cardno ChemRisk scientists have been previously engaged on this topic. Please see the “Risks in Combination” article published in The Synergist.