Creating a Culture of Prevention in Occupational Safety and Health Practice: Perceived Body Discomfort

Background and Context

Occupational injuries and diseases represent a major global public health burden. The International Labour Organization (ILO) has estimated that approximately 2.78 million workers die annually from work-related causes — roughly 7,600 deaths per day worldwide. An additional 340 million occupational accidents and 160 million victims of work-related diseases occur each year, resulting in economic losses equivalent to approximately 4% of global GDP. Work-related deaths in Asia account for approximately two-thirds of global workplace fatalities, making the region a priority area for occupational safety and health improvement.

Within this global landscape, the concept of creating a “culture of prevention” in occupational safety and health (OSH) practice has gained considerable attention. While technological improvements — including engineering controls, protective equipment, safer machinery, and adherence to regulations — have achieved significant reductions in workplace injuries over the past century, the rate of improvement has plateaued in many settings. This stagnation has prompted researchers and policymakers to examine the role of organisational culture and individual behaviour in determining workplace safety outcomes.

Perceived Body Discomfort as an Indicator of Ergonomic Risk

Perceived body discomfort (PBD) refers to the subjective experience of pain, stiffness, numbness, or other uncomfortable sensations in specific body regions that workers attribute to their occupational activities. It serves as an important early warning indicator of ergonomic risk exposure before the onset of clinically diagnosable musculoskeletal disorders (MSDs). Research has consistently demonstrated that biomechanical and postural stresses in the workplace correlate with both musculoskeletal injury rates and self-reported ratings of perceived body discomfort, validating PBD as a practical screening tool for identifying at-risk worker populations.

In the Malaysian manufacturing context, workers are frequently exposed to ergonomic hazards including repetitive motion, prolonged standing, awkward postures, forceful exertions, and vibration. The lower back, neck, shoulder, and upper extremities are the most commonly affected body regions. Studies conducted in Malaysian factories, assembly plants, and service industries have confirmed that the prevalence of musculoskeletal symptoms is high, with some surveys reporting that over 70% of workers in specific industries experience discomfort in at least one body region during the preceding 12-month period.

The Prevention Culture Framework

The ILO’s Promotional Framework for Occupational Safety and Health (Convention No. 187) defines a national preventive safety and health culture as one in which the right to a safe and healthy working environment is respected at all levels. Governments, employers, and workers are expected to participate actively in securing safe environments through defined rights, responsibilities, and duties, with prevention accorded the highest priority. This convention complements earlier instruments (Convention No. 155) that established basic principles for OSH management improvement.

The evolution towards a prevention culture involves several stages. Initial regulatory compliance — through labour inspections, enforcement of occupational health laws, and establishment of workplace standards — forms the foundation. The introduction of occupational health and safety management systems (OHSMSs) builds upon this foundation by providing structured frameworks for hazard identification, risk assessment, and continuous improvement. The international standard ISO 45001:2018, for instance, provides a globally recognised framework for systematic OSH management.

However, research has consistently shown that certification alone does not guarantee optimal OSH performance. Positive organisational culture and engaged management are necessary for OHSMSs to function effectively. The transition from a compliance-driven approach to a genuine prevention culture requires changes in attitudes, behaviours, and shared values at every level of an organisation.

Key Components of a Prevention Culture

The Malaysian Context

In Malaysia, the Department of Occupational Safety and Health (DOSH), operating under the Ministry of Human Resources, is the primary regulatory body responsible for ensuring workplace safety. The Occupational Safety and Health Act 1994 (Act 514) provides the legislative framework, supplemented by the Factories and Machinery Act 1967 and various industry-specific regulations. Despite this regulatory infrastructure, occupational disease reporting remains a significant challenge. The Occupational Safety and Health Master Plan 2021–2025 (OSHMP25) has set targets to increase occupational disease reporting by 30%, acknowledging the persistent problem of underreporting.

The Malaysian manufacturing sector, which employs a substantial proportion of the nation’s workforce, faces particular challenges related to musculoskeletal disorders. DOSH’s Guidelines on Ergonomics Risk Assessment at Workplace (2017) provide employers with tools for systematic ergonomic evaluation, yet implementation varies widely across industries and enterprise sizes. Small and medium enterprises (SMEs), which constitute the majority of Malaysian businesses, often lack the resources and expertise to conduct comprehensive ergonomic assessments.

Research published in MJPHM and related journals has documented the prevalence of work-related musculoskeletal disorders across diverse Malaysian occupational groups — from industrial manufacturing workers to healthcare professionals, from office-based employees to agricultural labourers. These studies consistently highlight the need for culturally appropriate ergonomic interventions that account for the specific environmental, organisational, and demographic characteristics of the Malaysian workforce.

Implications for Public Health Practice

Creating a culture of prevention requires coordinated action at multiple levels. At the national level, strengthening enforcement of existing regulations, improving the occupational disease surveillance system, and expanding access to occupational health services — particularly for SMEs and informal sector workers — are essential priorities. At the organisational level, integrating ergonomic risk assessment into routine operations, empowering workers to report discomfort without fear of reprisal, and investing in workstation redesign can yield substantial returns in terms of reduced absenteeism, improved productivity, and lower healthcare costs.

For individual workers, education on ergonomic principles, recognition of early warning signs of musculoskeletal strain, and adoption of protective behaviours — including regular stretching, proper lifting techniques, and adequate rest breaks — form essential components of personal prevention strategies. Health promotion programmes that address both workplace and lifestyle factors (including physical fitness, sleep quality, and psychosocial well-being) offer a comprehensive approach to reducing the burden of work-related musculoskeletal disorders.

Limitations

Research in this area faces several methodological challenges. Cross-sectional study designs, which are predominant in the Malaysian occupational health literature, cannot establish causal relationships between safety culture interventions and reductions in perceived body discomfort. Self-reported outcome measures are subject to recall and social desirability biases. The diversity of assessment tools used across studies limits comparability. Furthermore, the healthy worker effect — whereby workers with severe MSDs may leave the workforce, resulting in underestimation of prevalence in active worker populations — is an inherent limitation of workplace-based research.

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