CHILEAN MINE WORKER HEALTH - AIOH

CHILEAN MINE WORKER HEALTH

Workplace Health Promotion

HOLLY FLETCHER

University of Wollongong

School of Health and Society

May 2020

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Acknowledgements:

The researchers wish to acknowledge Codelco Andina and Clinica Rio Blanco who graciously offered the

resources and provided the access required to facilitate the collection of data.

Furthermore, the researchers wish to show special gratitude to Margarita Zambra Acevedo in facilitating the

standardised translation and testing of the research instruments and Maria Victoria Cox in supporting the

transcription and translation of the research data, results and final report and ensuring the integrity of such. We

are very grateful to both of you for your persistence and dedication.

Most significantly, the researchers wish to acknowledge all the research participants who volunteered their time

and effort to participate in this research. We are extremely grateful, as without your contribution this research and

associated body of knowledge would not have been possible.

Finally, but not least, the research team are forever grateful to Dr. José Ignacio Méndez Campos. Your incredible

commitment to this research and continual efforts to ensure resources were allocated and standardised data

collection systems were established meant this whole project was achievable. The words “thank you” are not

enough to express our gratitude.

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SUMMARY

In Chile, the average body mass index (BMI) in adults increased from 27.2 kg/m2 in 2010 to 28 kg/m2 in 2016 and

when compared to other countries, is rapidly becoming one of the most obese populations globally (WHO, 2016a).

Overweight and obesity are major risk factors of chronic diseases including cardiovascular disease, type 2

diabetes, hypertension and musculoskeletal dysfunction, and in the context of occupational environments is a

likely contributing factor to occupational injuries and illness (Anandacoomarasamy, et al., 2008), among other

adverse outcomes such as healthcare costs, reduced productivity and business performance (Batt, 2009).

Chilean organisation, the Mutual de Seguridad (The Mutual) operates to provide technical services for risk

prevention programs in workplaces, including occupational medical surveillance and the trending of such

population data. Analysis of data has subsequently identified those persons servicing the Chilean mining industry,

generally experience poor health outcomes, including overweight and obesity and musculoskeletal injuries. To

that effect, The Mutual partnered with the University of Wollongong’s (UOW) School of Health and Society to

research workplace interventions that could improve nutrition and physical activity-related behaviours, wellbeing

and decrease musculoskeletal injuries in Chilean mine workers.

The reasearch comprised of two main components. Firstly, a review of the current body of knowledge on the

effectiveness of workplace health promotion interventions. Secondly, population data was collected and analysed

from a representative Chilean mine operation.

This report communicates the results and conclusions of those research activities.

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Table of Contents

Summary .................................................................................................................................................................3

1 Introduction and Background .......................................................................................................................7

1.1 The “Obesogenic” Environment ................................................................................................................7

1.1.1 Risk of Non-Communicable Disease ................................................................................................7

1.2 Chilean Population Health ........................................................................................................................7

1.2.1 Obesity and the Chilean Adult Population ........................................................................................8

1.2.2 Physical Activity and the Chilean Adult Population ..........................................................................9

1.2.3 Chilean Adult Working Population ....................................................................................................9

2 Problem Definition and Relevance ...............................................................................................................9

2.1 Health Promotion Interventions ............................................................................................................. 13

2.1.1 Approaches to Health Prevention .................................................................................................. 13

2.1.2 Health Promotion in the Occupational Environment ...................................................................... 15

3 Literature Review ......................................................................................................................................... 15

3.1 Method ................................................................................................................................................... 15

3.2 Results ................................................................................................................................................... 16

3.2.1 Demographic Characteristics ......................................................................................................... 17

3.2.2 Health Promotion in the Occupational Environment ...................................................................... 18

3.3 Discussion.............................................................................................................................................. 19

3.3.1 Theoretical Framework for Health Promotion Interventions .......................................................... 19

4 Methodology................................................................................................................................................. 21

4.1 Participant Recruitment ......................................................................................................................... 21

4.2 Data Collection ...................................................................................................................................... 21

4.2.1 Questionnaire................................................................................................................................. 21

4.2.2 Interviews ....................................................................................................................................... 22

4.2.3 Group Medical Surveillance Data .................................................................................................. 22

5 Results .......................................................................................................................................................... 22

5.1 Study Population .................................................................................................................................... 23

5.2 Research Population Health Status ....................................................................................................... 24

5.3 Perceived Health ................................................................................................................................... 27

5.4 Value Placed on Good Health ............................................................................................................... 28

5.5 Desire for Change .................................................................................................................................. 30

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5.6 Organisational Support .......................................................................................................................... 33

6 Conclusions ................................................................................................................................................. 34

6.1 Literature ................................................................................................................................................ 34

6.2 Research Population ............................................................................................................................. 35

6.2.1 Health Beliefs and Attitudes ........................................................................................................... 36

6.3 Organisation Health Promotion.............................................................................................................. 37

6.4 Recommendations ................................................................................................................................. 38

6.5 Limitations .............................................................................................................................................. 39

7 References.................................................................................................................................................... 40

Tables

Table 1 – Prevalence of Chronic Disease and Risk Behaviours: Chilean Adult Population - 2010 .........................8

Table 2 – Andina Mine Operation Pre-Occupational Medical Examination Data (2015 – 2016) .......................... 10

Table 3 – Specific Conditions Precluding Employment (Employment applications in 2016) ................................ 10

Table 4 – Andina Mine Occupational Medical Examination Data (2015 – 2016) .................................................. 11

Table 5 – Specific Conditions Precluding Continued Employment (2016) ............................................................ 11

Table 6 – Specific Conditions Temporarily Restricting Employment (2016) ......................................................... 12

Table 7 – Comparison of Quantities in Literature Search Results ........................................................................ 17

Table 8 – Characteristics Associated with Identified Reference ........................................................................... 17

Table 9 – Conclusion: Literature Regarding the Effectiveness of Health Promotion Interventions ....................... 35

Table 10 – Conclusion: Health Status of the Research Population ...................................................................... 36

Table 11 – Conclusion: Health Beliefs and Attitudes ............................................................................................ 37

Table 12 – Conclusion: Organisational Health Promotion ..................................................................................... 38

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Figures

Figure 1 – Mean BMI of Chilean Adults Compared to Other Global Populations ....................................................9

Figure 2 – Method for Selecting and Including Literature for Review ................................................................... 16

Figure 3 – Conceptual model for integrating health promotion into existing systems ........................................... 20

Figure 4 – Participant Age ..................................................................................................................................... 23

Figure 5 – Duration of Employment with Codelco Andina ..................................................................................... 24

Figure 6 – Level of Supervisor Responsibility ....................................................................................................... 24

Figure 7 – Prevalence of Overweight and Obesity ................................................................................................ 25

Figure 8 – Prevalence of Raised Blood Pressure ................................................................................................. 26

Figure 9 – Elevated Fasting Blood Glucose .......................................................................................................... 26

Figure 10 – Prevalence of Elevated Cholesterol ................................................................................................... 26

Figure 11 – Mean Systolic Blood Pressure ........................................................................................................... 26

Figure 12 – Self-Reported Health Status ............................................................................................................... 27

Figure 13 – Prevenance of Chronic Disease ......................................................................................................... 28

Figure 14 – Difficulty Accomplishing Work Tasks Due to Health .......................................................................... 29

Figure 15 – Psychosocial Work Environment Demands, Support, Security and Use of Skills ............................. 30

Figure 16 – Daily Commute Duration .................................................................................................................... 30

Figure 17 – Job Satisfaction and Intention to Leave ............................................................................................. 31

Figure 18 – Justice and Civil Norms ...................................................................................................................... 32

Figure 19 – Motivation to Adopt Healthier Lifestyles ............................................................................................. 32

Figure 20 – Health Opportunities at Work ............................................................................................................. 33

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1 INTRODUCTION AND BACKGROUND

The Mutual de Seguridad (The Mutual) in Chile and the University of Wollongong (UOW) partnered to undertake

research to identify health interventions that could improve the health of Chilean mine workers. The outcomes of

the research is described within this report.

1.1 The “Obesogenic” Environment

Economic growth and development have profoundly influenced the “globalisation” of economies, people and

resources, affording once marginalised populations with now attractive benefits including employment, education

and access to health care and other services. Health benefits associated with globalisation have been evidenced

by substantial life expectancy increases across all developing countries, a trend expected to continue in the 21st

century (Baum 2008). However, while global populations have achieved high levels of health and well-being, such

health benefits have been opposed by significant and ever-increasing health inequalities including unhealthy diets,

physical inactivity, tobacco smoking, alcohol consumption and climate change stressors (WHO 2016a).

Of all the above-mentioned inequalities, the impact of urban development on physical activity and diet has been

the most profound as residing, working and playing in now globalised “urban environments” significantly demands

lower energy expenditure as energy intense manual labour becomes replaced by sedentary occupational demands

and leisure activities. Modern global commerce, advanced food production, technology and transportation have

promoted low-cost, energy-dense foods on the domestic food market in many developed and developing countries.

Consumption of high energy food combined with reduced energy expenditure has directly contributed to a global

obesity epidemic (Rydin et al. 2012).

The relationship between globalisation and obesity was first observed in developed countries during the 19th and

20th centuries and by the year 2000, for the first time in human evolution, the number of obese adults surpassed

the number of those who were underweight. Obesity is now considered a global health threat and major risk factor

for chronic diseases including cardiovascular disease, type 2 diabetes and hypertension (WHO 2015).

Multiple factors influence obesity in individuals, including genetic predispositions. However, the speed of obesity

prevalence observed in global populations over the past 30 years indicate social and environmental factors play a

significant role in determining obese population outcomes (Rydin et al. 2012).

1.1.1 Risk of Non-Communicable Disease

Overweight and obesity adversely affect blood pressure, cholesterol, triglycerides and insulin resistance. As an

individual’s body mass index (BMI) increases, so too does their risk of mortality and non-communicable diseases

including coronary heart disease, ischemic stroke and type 2 diabetes mellitus, cancer of the breast, endometrium,

colon, prostate, kidney and gall bladder (WHO 2015). For an adult population to achieve optimum health, the

median BMI should be between 21 to 23 kg/m2, while individuals should maintain a BMI between 18.5 to 24.9

kg/m2. Chronic disease risk increases where an individual’s BMI is greater than 25 kg/m2 and becomes significant

where a BMI of > 30 kg/m2 is realised (WHO 2016a).

1.2 Chilean Population Health

Economic growth and development and unhealthy diet and physical inactivity inequalities have been observed in

Chile (Albala et al. 2002), where the Chilean population over the past three decades has experienced rapid

“nutritional transition”, a term used to characterise the predictable changes in the dietary patterns of a population

associated with economic development and increased wealth (Health 2016). Continued economic growth in the

1990’s resulted in income per capita almost doubling from US$2,600 in 1987 to US$5000 in 1997, of which Vio et

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al. (2008) report a significant proportion “has been spent on processed foods, rich in fat, sugar and salt, television

sets, appliances and cars” and leading to increases in the prevalence of overweight and obesity so significant that

in 1998 the Chilean Ministry of Health (MOH) prioritised a set of goals to reduce the prevalence of overweight and

obesity in the Chilean population between 2000 and 2010 (Albala et al. 2002).

Regardless of intent, the goals established to reverse the prevalence of obesity have proven difficult to convert

into action, primarily because of physical inactivity and consumption of foods high in fat, sugar and salt (Vio et al.

2008). This combined with weak political decision-making contributes to the increased risk of non-communicable

disease (Vio et al. 2008, Celis-Morales et al. 2016) such as those recorded in 2010 by the MOH and displayed in

Table 1.

Table 1 – Prevalence of Chronic Disease and Risk Behaviours: Chilean Adult Population - 2010

DIAGNOSIS/RISK BEHAVIOUR Women % Men % Total %

Obesity 30.7 19.2 25.1

High blood pressure 25.3 28.7 26.9

Hypercholesterolemia 38.1 39.0 38.5

High/moderate cardiovascular risk 37.3 56.4 45.3

Diabetes 10.4 8.4 9.4

Current smoker 37.1 44.2 40.6

Alcohol consumption in last week 24.8 48.0 36.1

(ILO 2012).

1.2.1 Obesity and the Chilean Adult Population

In Chile, 63% of adults aged over 18 years are estimated to be overweight (BMI ≥ 25 kg/m2) and 28% obese (BMI

≥ 30 kg/m2), such rates associated with increased BMI are consistent with those observed in high-income countries

(WHO 2016a).

Despite efforts of the Chilean MOH, the mean BMI of the Chilean population increased from in 27.2 kg/m2 in 2010

to 28 kg/m2 in 2016 and when compared to other countries (Figure 1), is rapidly becoming one of the most obese

populations globally (WHO 2016a).

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Figure 1 – Mean BMI of Chilean Adults Compared to Other Global Populations

1.2.2 Physical Activity and the Chilean Adult Population

In 2010, 21% of Chilean adults aged over 18 years were estimated to be insufficiently active, a trend consistent

with low-middle income countries. Chilean women were less active than men, with respective differences of 18%

and 25% (WHO 2016a) and comparable to men and women in low-income countries (18% and 21% respectively).

It is interesting to note that the prevalence of physical inactivity observed in the Chilean population is half of that

observed in males and females in high-income countries where rates of insufficient physical activity are 41% and

48% respectively.

1.2.3 Chilean Adult Working Population

The prevalence of obesity and physical inactivity in the general adult population implies such incidences can also

be observed in the adult working population (Baum & Sanders 1995), and in such cases is a likely contributing

factor to occupational injuries and illness (Anandacoomarasamy, et al., 2008), among other adverse outcomes

such as healthcare costs, reduced productivity and business performance (Batt 2009).

2 PROBLEM DEFINITION AND RELEVANCE

Trending of population data, obtained by The Mutual through their medical surveillance services has identified that

the Chilean mining industry workers generally experience poor health outcomes, including overweight and obesity

and musculoskeletal injuries, and while high-level Chilean population characteristics associated with overweight

and obesity and physical inactivity are known and understood, little information is known about the prevalence of

such characteristics in subpopulations for example, occupational groups (Celis-Morales et al. 2016). An in-depth

understanding of the health determinants and subsequent distribution of risk within the Chilean population is

therefore required to better inform the design and implementation of health prevention strategies (Baum 2008).

To better define the problem, high-level data regarding the health status of the population at Codelco’s Andina

Mine Operation (Table 2 and Table 4) was sourced (Codelco, 2018) and is further elaborated on below.

The data presented in Table 2 demonstrates the percentage of personnel precluded from employment in 2015

and 2016 at Andina Mine Operation on grounds of not meeting the medical criteria for occupational altitude

exposure.

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Table 2 – Andina Mine Operation Pre-Occupational Medical Examination Data (2015 – 2016)

PRE-OCCUPATIONAL MEDICAL EXAMINATIONS

Year 2015 2016

Number of exams performed 193 439

% contraindicated 15% 16%

Such results are considered significant. Further data provided by Codelco regarding specific conditions are

presented in Table 3 and demonstrate that of the 69 persons precluded from employment, 43 (or 62%) were due

to cardiovascular and metabolic abnormalities with overweight and obesity being major contributing factors

(Méndez, 2018).

Table 3 – Specific Conditions Precluding Employment (Employment applications in 2016)

OCCUPATIONAL HEALTH EVALUATION OF APPLICANTS (Year 2016, N=439)

GROUP OF DISEASES SPECIFIC CONDITION No No Total

CARDIOVASCULAR AND

METABOLIC

Obesity + Dyslipidemia 12

43 Obesity + BP > 140/90 mmHg 12

BP >140/90 mmHg 12

Disturbance ECG 7

Obese (BMI > 35) 10

15 Diabetes mellitus untreated 5

Dislipidemia 3

RESPIRATORY Chest Disturbance 3 3

HEMATOLOGICAL Anemia 2

3 Polycythaemia 1

OBSTETRICS Declared pregnancy 2 2

SUMMARY

TOTAL CONTRAINDICATED 69

TOTAL EVALUATED 439

% CONTRAINDICATED 16%

The data presented in Table 4 demonstrates the percentage of personnel already employed by Codelco at the

Andina Mine Operation and either temporarily restricted from continuing work or permanently restricted from

continued employment in 2015 and 2016 (Méndez, 2018).

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Table 4 – Andina Mine Occupational Medical Examination Data (2015 – 2016)

OCCUPATIONAL MEDICAL EXAMINATIONS

YEAR 2015 2016

N° of exams performed 1151 1483

% temporary contraindicated 8.4% 11.3%

N° of recovery days 13 11

% permanently contraindicated 1.2% 1.9%

Specific conditions preventing continued employment with Codelco in 2016 are presented in Table 5 and

demonstrate 21 of the 29 persons (72%) medically unfit were due to cardiovascular and metabolic conditions, with

overweight and obesity being high risk factors.

Table 5 – Specific Conditions Precluding Continued Employment (2016)

OCCUPATIONAL HEALTH EVALUATION OF WORKERS (N=1483) - NON-REVERSIBLE RESTRICTIONS


CARDIOVASCULAR

Coronary cardiopathy 10

15

Arrhythmias difficult to manage 2

Hypertrophic cardiomyopathy 1

Refractory arterial hypertension 1

Aortic aneurysm 1

METABOLIC

Diabetes mellitus 2 unstable 3

6 Unstable diabetes mellitus 2 and obesity 2

Morbidly obese 1

RESPIRATORY Pulmonary embolism 2

3 Advanced COPD 1

HEMATOLOGICAL High persistent Hb (Polycythaemia) 1 1

GASTROENTEROLOGY Advanced liver failure 1 1

NEPHROLOGY Advanced chronic kidney failure 1 1

NEUROLOGICAL Uncontrolled epilepsy 1 1

PSYCHIATRIC Severe mood disorder 1 1

SUMMARY


TOTAL EVALUATED 1483


Specific conditions temporarily restricting employment with Codelco in 2016 are presented in Table 6 and

demonstrate 76 of the 167 persons (46%) were temporarily unfit due to cardiovascular abnormalities, while 67 of

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the 167 persons (40%) were temporarily unfit due to metabolic abnormalities and include severe obesity, Type 2

diabetes and high blood triglyceride levels (Méndez, 2018).

In circumstances where person’s employment is temporarily restricted, such persons are referred for specialist

treatment before returning to their role and continued occupational altitude exposure. The average treatment

duration was 11 days (Méndez, 2018).

Table 6 – Specific Conditions Temporarily Restricting Employment (2016)

OCCUPATIONAL HEALTH EVALUATION OF WORKERS (N=1483) - REVERSIBLE RESTRICTIONS


CARDIOVASCULAR AND METABOLIC

BP >140/90 mmHg 44

76

Disturbance in ECG 8

Coronary cardiopathy 3

BP >140/90 mmHg + BMI >35 9

High CV risk by Framingham 6

BP >140/90 mmHg + High blood sugar 4

Arrhythmia in study 1

Temporary TACO 1

High blood sugar / Diabetes mellitus 2 23

67 BMI >35 27

Triglycerides > 500 mg/dL 17

HEMATOLOGICAL Polycythaemia 12

15 Polycythaemia + BMI>35 3

OBSTETRICS Pregnancy 6 6

NEUROLOGICAL Cerebrovascular accident (un sequenced) 2

3 Sleep disorder 1

SUMMARY


TOTAL EVALUATED 1483


The health status of the population at the Andina Mine Operation indicated in Table 5 and Table 6 demonstrate

an increase in the prevalence of cardiovascular abnormalities, along with metabolic abnormalities including severe

obesity, Type 2 diabetes and high blood triglyceride levels. Such abnormalities are reportedly impacting workers

occupational function and resulting in either temporary work restrictions or in extreme cases continued

employment, as was the case of 1.2% of workers in 2015 and 1.9% of workers in 2016 (Méndez, 2018).

The prevalence of abnormalities associated with overweight and obesity, and the consequences of such

demonstrate both the relevance and importance of research to determine effective interventions to improve health

outcomes in Chilean mine workers.

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2.1 Health Promotion Interventions

The Ottawa Charter for Health Promotion and its view on health has been described as the third public health

revolution (Baum 2008, Kickbusch 2007) conceptualising health as a “resource for everyday life, not the object of

living” (WHO 2016b). The Charter, underpinned by a “Health for All” philosophy, facilitated a shift in focus from

factors that cause disease to those that support human health and well-being and subsequently became the driving

force of the “New Public Health” movement. Health Promotion was introduced as a salutogenic approach1 with the

objective of improving the health of populations and involving health sciences, economic, political, cultural and

social sectors of government to guide interventions and reduce systematic, avoidable, and unjust differences in

health between individuals and population sub-groups (Ridde et al. 2007). It proposed a revolutionary shift in

perspective from input to outcomes and governments were to be held accountable for the health of their

populations, not just for the health services they provided (Hancock 2007).

2.1.1 Approaches to Health Prevention

Health systems fundamentally aim to prevent disease and reduce illness such that populations remain as healthy

as possible for as long as possible. Health determinants and subsequent distribution of risk within populations

therefore significantly impact upon the design and implementation of health prevention strategies. Two common

approaches to health prevention have been described and include “Population-Level” strategies, designed to

target and reduce average risk levels in whole populations, regardless of exposure to risk factors or not, and “High-

Risk” strategies, designed to target identified high-risk individuals within a population (Ridde et al. 2007). Both

strategies offer unique advantages and disadvantages and are further discussed below.

2.1.1.1 Population Level Interventions

‘Population level’ strategies are those interventions which specifically target health determinants to improve overall

health by shifting the distribution of risk factors rather than preventing specific diseases. Such interventions

typically take the form of laws and regulations, tax and price interventions, built environment improvements,

awareness campaigns and community-based interventions. At times such interventions may be deployed in

parallel, for example, the implementation of a community-based intervention to improve the built environment and

the corresponding introduction of laws that mandate taxation on health-harming products. While such strategies

intend to reduce exposures and create healthy behaviours into social norms such that the entire population risk is

lowered, they are often difficult to implement as such interventions require collaboration between a number of

societal sectors, each of which often oppose the interests of one another (Ridde et al. 2007).

The advantage of population-level interventions includes addressing the root causes of illnesses to reduce the

incidence and modify the whole population risk profile, including those at low or average risk. Potential gains at a

population level are extensive, however, are often opposed, as preventive measures that afford significant

population change will only appear to offer little benefit to each participating individual, subsequently unfavourably

affecting population motivation at large (Hunt & Emslie 2001). This observable disadvantage was first described

in 1981 as the "prevention paradox" by epidemiologist Geoffrey Rose, characterised as one of the most

fundamental axioms now used in preventive medicine, that is, "a large number of people exposed to a small risk

may generate many more cases than a small number exposed to high risk" (Rose 2001). Rose indicated wherever

this axiom applies, preventive strategies focusing on high-risk individuals will marginally address the issue and

1 Salutogenic Approach – A medical approach to health promotion that focuses on factors that support human health and wellbeing, rather than focusing on factors that cause disease.

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subsequently will not impact the large numbers of disease occurring in the moderate risk population (Hunt & Emslie

2001).

Population-level health interventions observed historically in developed countries include well known tobacco

control interventions, now in place for over two decades and include multi-faceted interventions combining tobacco

control laws, regulating businesses to provide smoke-free environments, controlling sales, enforcing restrictions

on advertising including graphic warning labels and sales tax on tobacco products (Wakefield et al. 2014).

Evaluation of interventions on smoking prevalence among adults between 2001 and 2011 demonstrated increased

tobacco taxes, toughened smoke-free laws, increased exposure to tobacco control mass media campaigns and

pharmaceutical company advertising for nicotine replacement therapy contributed to a reduction in smoking

prevalence from 23.6% to 17.3% with stronger smoke-free laws, increased tobacco taxation and greater exposure

to mass media campaigns independently contributing to 76% of the decrease in smoking prevalence (Wakefield

et al. 2014).

Not all population prevention initiatives demonstrate such success, particularly those that rely on mass social

marketing as the only method of intervention (Grunseit et al. 2015; King et al. 2013). Examples of such include the

'Life be in it' and ‘Swap it, don’t drop it’ lifestyle campaigns implemented in Australia in 1977 and 2011 respectively.

Such campaign initiatives, focused on the personal exercise and eating behaviours of individuals, and although

they were inherently plausible at an individual level, such interventions failed to consider the broader social and

environmental contexts in which personal behaviours are embedded (Baum 2011, Christakis & Fowler 2007).

The fact that obesity prevalence is increasing globally, demonstrates interventions that rely on telling people to

change their lifestyles and to be healthier have a limited impact on population health, and if anything act to increase

inequities (Baum 2011, Grunseit et al. 2015, King et al. 2013).

2.1.1.2 High-Risk Interventions

The ‘high-risk’ approach to health prevention inherently relies on the assistance of medical professionals to identify

those persons with risk factors or medical conditions and prescribe interventions that aim to prevent disease

development within the individual.

The advantage of high-risk approaches is interventions are specific to the target individual. Therefore, individuals

are more likely to be motivated and intervention compliant, such advantage is also disadvantageous as treating

individuals results in little impact on the population disease burden as most cases of disease occur in low or

moderate risk people and therefore predicting new cases is difficult (Hunt & Emslie 2001).

High-risk population interventions often promote an over-reliance on the medical health model which consequently

distracts the attention of policy makers away from crucial longer-term adjustments to social and economic policy

(Kickbusch 2015). Baum and Sanders (1995) provide interesting discussion regarding the political advantage of

such, offered historically to those in power, as such circumstances provided maintenance of the status quo. As

previously discussed, chronic disease has replaced infectious disease as the main cause of mortality and

morbidity, this combined with population growth and global population movement mean that the medical health

model, currently relied upon is no longer economically sustainable (Ridde et al. 2007).

Vartiainen et al. (2011) compared the effectiveness of both population and high-risk strategies for cardiovascular

disease (CVD) outcomes in rural Australians between 2004 to 2006, including modelling the effect of changing

risk factors at a population level, among the high-risk individuals, and both to assess the extent of interventions

on CVD prevention.

Results demonstrated the high-risk strategy could reduce cardiovascular events by 12.6% (126 per 1000), the

population strategy by 19.3% (193 per 1000 per 5 years) and when both strategies were combined, a 24.1%

reduction in cardiovascular events (241 per 1000) could be achieved (Vartiainen et al. 2011).

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The results of the study demonstrate the advantages of treating high-risk individuals to reduce the mean risk-factor

levels in the population, however, also highlight the greater impact overall when high-risk and population strategies

are combined (Vartiainen et al. 2011).

A fundamental aim of any health intervention is to prevent disease and reduce ill health and in practice, as indicated

in the Ottawa Charter, requires preventative health strategies that target different levels, individuals, communities,

and populations simultaneously (WHO 2016b).

2.1.2 Health Promotion in the Occupational Environment

As previously discussed, the Ottawa Charter for Health Promotion is the foundation reference for health promotion

and is considered the strategic framework of the new public health movement to reduce inequalities in health

globally (Labonté 2011). The Charter is founded on the principle that health is created by people within the settings

of their everyday lives, that is, where they live, work and play (WHO 2016b). As such, the workplace has been

recognised by the World Health Organisation (WHO) (2016c) as a setting which significantly “influences the

“physical, mental, economic and social well-being of workers and in turn the health of their families, communities

and society” and therefore has been prioritised as a setting for health promotion.

One such appropriate workplace setting is mining operations, typically established in regional and remote locations

and requiring workers to reside “on-site” for extended periods of time to work and service mining operation

activities. In such environments, food is provided to the workers from an onsite kitchen and such may influence

eating behaviours resulting in over consumption of energy dense nutrient poor food and leading to overweight and

obesity. In Australia, 76% of workers in the mining industry are classified as overweight or obese, the highest

among all national industries (ABS 2008). Such observable patterns may be comparable or even higher in Chile.

However, data to inform such assumptions is currently lacking.

Over the past two decades a framework and associated body of knowledge has emerged that aims to

systematically integrate health promotion in the workplace with traditional occupational health and safety programs

designed to protect workers (NIOSH 2008) and have been founded on the theory that interventions which target

both the workers knowledge and skills, and create a supportive environment for health are more likely to be

successful and sustainable (Seabury et al. 2005). In 2011, the framework and supporting theoretical knowledge

was given the term Total Worker Health® (TWH) by the National Institute of Occupational Safety and Health

(NIOSH) for purposes of expanding dialogue between researchers, practitioners, business leaders and organised

labour representatives such that traditional occupational safety and health programs could be expanded to include

wellness and well-being (Sorensen et al. 2016a). The thoretical framework supporting TWH interventions is futher

discussed and elaborated upon in the literature review Discussion Section.

3 LITERATURE REVIEW

A systematic literature review was conducted with the objective of identifying and evaluating evidence supporting

the effectiveness of interventions conducted in the occupational environment which improves worker’s nutrition

and physical activity-related behaviours and supports the identification of future research on improving wellbeing

and decreasing musculoskeletal injuries in Chilean mine workers.

3.1 Method

A literature seach strategy was applied to identify peer-reviewed literature published between 2000 and 2018 in

multiple databases. Literature was eligible for inclusion if the study pertained to a workplace setting and specifically

measured the effectiveness of interventions implemented for purposes of improving workers diet and physical

activity related outcomes.

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3.2 Results

Literature included in the review were selected in accordance with Figure 2.

Figure 2 – Method for Selecting and Including Literature for Review

Initial database searching returned 48,283 individual references, which was further refined to 439, the majority of

which were excluded for reasons cited in Figure 2. Further eligibility assessment resulted in the identification of

ten (10) literature sources and included three (3) systematic literature reviews, one (1) meta-analysis, one (1)

cross-sectional study, one (1) mixed methods study, three (3) randomised control trials (RCT’s) and one (1) cluster

RCT. It should be noted the cluster RCT was a study conducted for purposes of piloting and evaluating a workplace

intervention, however, was included in the review as results relevant to the design and implementation of the

intervention were consistent with other studies included in the review.

Although the quantity of references selected for inclusion in this initial literature review may be considered sparse,

such search results are consistent with efforts applied by those listed in Table 7 and is attributed to excluding any

reference source which failed to identify and articulate evidence associated with the effectiveness of improving

worker health outcomes. The lack of reliable references are a significant limitation, a view supported by Anger et

al. (2015), who report “there is insufficient evidence or replication to identify best practice interventions based on

the literature”.

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Table 7 – Comparison of Quantities in Literature Search Results

Study Number of Databases

Searched Search Results

Reference Material

Meeting Inclusion

Criteria

(Anger et al. 2015) 4 3,694 17

(Bully et al. 2015) 2 5,189 30

(Osilla et al. 2012) 6 1,555 33

(Rongen et al. 2013) 3 3,668 18

3.2.1 Demographic Characteristics

Of the ten (10) literature sources, six (6) studies were all conducted in the United States, while all remaining four

(4) literature reviews (including meta-analysis) included studies all carried out in developed countries, except Brazil

(Rongen et al. 2013). Industries included in studies were limited to universities, hospitals, manufacturing and

construction, among others listed in Table 8.

Table 8 – Characteristics Associated with Identified Reference

Study Research

Method

Target Health

Outcomes Population Industries | Occupations

(Anger et al. 2015)

Systematic

Literature

Review

Weight

Physical Activity

Smoking

Blood Pressure

Cholesterol

Australia

Denmark

Germany

Japan

Norway

United States

Manufacturing

Construction

Services

Health Care

Telecommunications

Transportation

(Bully et al. 2015)

Systematic

Literature

Review

Physical activity

Diet

Alcohol and

Tobacco Use

UK

Australia

Canada

Germany

Switzerland

Spain

United States

Not reported

(Osilla et al. 2012)

Systematic

Literature

Review

Exercise

Diet

Healthcare cost

Smoking

Alcohol use

Absenteeism

Mental health

United States

Services

Manufacturing

Transportation

Trades

(Rongen et al.

2013) Meta-Analysis

Smoking

Physical Activity

Healthy Nutrition

Australia

Netherlands

Sweden

Casino

Health Care

Commercial/financial Services

18

Study Research

Method

Target Health

Outcomes Population Industries | Occupations

Work Absence Work

Productivity

Finland

Brazil

Spain

Germany

Japan

Norway

United States

Nursing and Home Care

Construction

Transportation

Aluminium refining

(Gazmararian et al.

2013) RCT Physical Activity United States University

(Hopkins et al.

2012) Custer RCT Physical Activity United States University

(Østbye et al.

2013) RCT

Physical Activity

Dietary Intake United States University

(Thorndike et al.

2012) RCT

Physical activity

Diet United States Hospital

(Tamers et al.

2011)

Cross-sectional

study

Physical activity

Weight United States

Transportation,

Manufacturing,

Utilities,

Personal, Household, and

Miscellaneous services

(Sorensen, G et al.

2016b) Mixed Methods

Musculoskeletal

disorder risks; and

Personal risk factors

United States Hospital

It is interesting to note the prevalence of studies conducted in the United States, a likely result of a National focus

on disease prevention, prompted by the introduction of the 2010 Patient Protection and Affordable Care Act

(Michaels & Greene 2013), and consistent with the publication dates of relevant literature (Gazmararian et al.

2013, Hopkins et al. 2012, Osilla et al. 2012, Sorensen, G et al. 2016b, Tamers et al. 2011, Thorndike et al. 2012)

and targeted health outcomes, particularly weight and physical activity, both significant risk factors requiring control

for the prevention non-communicable diseases, as discussed in the previous Section on Approaches to Health

Prevention.

3.2.2 Health Promotion in the Occupational Environment

Literature search efforts demonstrated a significant body of knowledge has been published regarding workplace

interventions intended for application in developed countries, such as the United States and in workplaces likely

to have reliable systems that support the implementation of such workplace interventions (Mattke et al. 2013).

Earlier discussion regarding the global obesity epidemic therefore not only warrants, however, prioritises the

design and testing of workplace interventions that can be applied in developing countries and subpopulations

populations, such as Chilean mine workers for purposes of reducing risk factors associated with overweight and

obesity.

19

Studies relevant to the effectiveness of health promotion interventions implemented in the mining industry were

not identified in any of the sources, nor were studies relevant to the Chilean working population, therefore

reinforcing the priority for research efforts.

The abundance of reference material has been surmised by Mattke et al. (2012), who reports many employers

provide anecdotal evidence and express support and for workplace wellness programs, particularly with regards

to improvements in worker health and reductions in healthcare costs. Statements which have been further

supported by independent literature review (Mattke et al. 2013) demonstrating evidence of positive effects on diet

and exercise, smoking and alcohol use and health care costs, however, limited evidence of effects on absenteeism

and mental health. It is important to note however, that such findings were not conclusive as positive correlations

associated with intervention intensity are likely to contribute to reported outcomes.

Mattke et al. (2012) conclude that the strength of such evidence is currently insufficient to conclusively assess the

impact of workplace health interventions on worker health outcomes. The abundance of peer-reviewed literature

reports mostly positive outcomes, however, such literature only encompasses a minor proportion of the abundance

of interventions, and therefore prompts questions with regards to the generalisability of reported findings,

particularly in developing countries and in subpopulations.

As such, research is needed to evaluate the impact of workplace health interventions in “real world” settings such

that policymakers are informed when making decisions and improved health outcomes are achieved.

One such research method is supported by a “Total Worker Health” framework, which when applied, establishes

to integrate policies, programs, and practices within the workplace that focus on health and safety activities that

advance the overall well-being of individual workers, their families, communities, employers and the economy as

a whole (Sorensen et al. 2016a).

3.3 Discussion

For people to remain as healthy as possible for as long as possible, health prevention strategies comprising both

“Population-Level” and “High-Risk” strategies, described previously are necessary and are important to ensure

efforts are effective and support sustained positive behaviour change (Hunt & Emslie, 2001). Such approaches

when implemented are complementary, however, require considerable balance. Finding that balance is the

challenge as described by Rose (2001) and requires oversight of disease, its causes and solutions, ultimately

leading to the acknowledgement and development of strategies that address the broader social and environmental

determinants of disease.

Literature review activities identified the Total Worker Health® framework as one specific strategy that can be

applied in the occupational environment to improve worker’s nutrition and physical activity-related behaviours while

supporting improved wellbeing and decreasing musculoskeletal injuries in Chilean mine workers. Such is further

discussed below.

3.3.1 Theoretical Framework for Health Promotion Interventions

In 2011, the Total Worker Health® (TWH) framework was termed by NIOSH to expand the dialogue between

researchers, practitioners, business leaders and organised labour representatives for purposes of expanding the

theoretical knowledge that supports the integration of health promotion interventions into traditional occupational

safety and health programs (Sorensen et al. 2016a).

Sorensen et al. (2016a) most recently published a conceptual model (Figure 3) with the intention of guiding social

epidemiological research on the determinants of worker health and safety for purposes of informing the design,

implementation and evaluation of strategies that promote and protect worker health. The conceptual model

20

embeds multiple theories, enhances NIOSH’s TWH framework and contributes to the growing body of knowledge

and associated evidence demonstrating the benefit of integrated interventions on health behaviours.

The model, represented in Figure 3, was developed by the Centre for Work, Health and Well-being at the Harvard

School of Public Health, and is founded on the premise that policies, programs and practices designed to address

multiple pathways within the work environment in an integrated manner, will result in improved health outcomes

far greater than that what would be expected if each pathway was addressed individually, as such Sorensen et al.

(2016a) report the model is expected to “provide a valuable tool for future research aimed at testing the

effectiveness of integrated approaches to worker health protection and health promotion, as well as a framework

for translating research to practice”.

Figure 3 – Conceptual model for integrating health promotion into existing systems

Figure 3 pictorially demonstrates each model component and the many pathways through which policies,

programs and practices concurrently operate and affect the conditions of work. As such, the physical work

environment and organisation of work, along with mediating effects on health behaviours are central to the model

as determinants of health and safety outcomes. The model demonstrates the relationship of such work conditions,

along with the potential influence of business and workforce characteristics and where policies, programs and

practices may contribute to improvements in business performance such as turnover and workers’ compensation

and health care costs. It is fundamental to recognise however, that such relationships occur within the context of

labour market and economic trends, legal and political forces, and most importantly within the context of social

norms and cultural influences (Sorensen et al. 2016a).

It is important to note that although the model is conceptual, it has been structured by applying multiple theoretical

frameworks including the social-ecological model, social contextual model of health behaviour change, hierarchy

of controls, organisational ergonomics, community-based participatory research framework, job strain and

sociotechnical systems theory. Such diverse theoretical foundations demonstrate the complex interaction of

factors between individual workers and their immediate work environment and the characteristics associated with

the broader context in which both the worker and the worksite are embedded. Understanding and designing health

interventions that take into consideration the broader context in which health behaviours occur are more likely to

be successful and sustainable as such interventions will be implemented to address pathways across multiple

dimensions (Sorensen et al. 2016a).

As such, the model affords both research and practice a systematic approach to identifying the causal pathways

through which work influences health outcomes, and in particular, designing and testing interventions that are

responsive to workplace conditions that are meaningful for workers and employers and are successful in improving

health behaviours (Sorensen et al. 2016a).

21

4 METHODOLOGY

4.1 Participant Recruitment

Participant recruitment and data collection activities took place at Clinica Rio Blanco’s Occupational Health Unit in

Los Andes, Chile. Clinica Rio Blanco are contracted by Codelco Andina to provide occupational health services

including pre-employment evaluations and periodic medical surveillance for those employed by Codelco’s Andina

Division.

All Andina employees attending the clinic to participate in periodic health evaluation activities were invited to

participate in the study, a total of 242 persons were recruited between September 30, 2019 and February 28,

2020.

4.2 Data Collection

Data collection activities included the administration and analysis of 242 questionnaires and 40 face-to-face

interviews were performed to gain an understanding of the extent of overweight, obesity and physical activity in

the study population and contextualise the social, environmental and cultural variables that influence such health

outcomes (Ivankova et al. 2006)

In addition to the above, de-identified group medical surveillance data was also examined for purposes of

comparing non-communicable disease risk factors in the study population with the Chilean adult population.

Translation and Adaptation of Research Instruments

The forward-translation and back-translation method (WHO, 2020) was followed to translate and adapt the All

Employee Survey (CPH-NEW 2014) and interview questions such that both instruments were culturally and

conceptually equivalent in Chile, this method included:

1. Forward Translation of the instruments from English into Spanish;

2. Review of the translated instruments, specifically the words, intent of questions and concepts to ensure

inadequate expressions and concepts were identified and resolved;

3. Back Translation of the instruments from Spanish into English, specifically limited to terms and concepts

that were considered fundamental to the instrument and those that were identified as sensitive to cross

cultural translation; and

4. Pre-Testing of the each modified instrument with a sample of the target population.

4.2.1 Questionnaire

Questionnaires were self-administered by all study participants (n = 242) whilst they waited to participate in

scheduled medical evaluations at Clinica Rio Blanco.

The questionnaire was a modified version of the Healthy Workplace All Employee Survey developed by

researchers at the Center for the Promotion of Health in the New England Workplace (CPH-NEW 2014).

The questionnaire was deployed for purposes of assessing worker attitudes in relation to their physical and

psychosocial work environment, including factors that support or reduce a healthy worksite culture, in addition to

capturing the participant’s perceived health and associated health behaviours.

22

4.2.2 Interviews

Semi-structured face-to-face interviews were conducted with 40 participants, already recruited into the study. The

interviews were conducted for exploratory purposes and followed a standardised set of questions designed to

identify themes and trends in participants lived experiences, beliefs and values.

The face-to-face interviews were administered by a Chilean national member of the research team, with audio

recordings of each interview. Each audio recording was transcribed into written text (Spanish). Following

transcription, the participants were provided with the opportunity to review their transcript for accuracy and

completeness through the Chilean research team member. Following revision, each transcript was translated from

Spanish into English by a Chilean professional translator for purposes of analysis and interpretation.

4.2.3 Group Medical Surveillance Data

Chilean legislation introduced in 2012, requires all persons occupationally exposed to high altitude (> 3000 m) to

participate in annual medical surveillance. The altitude of Codelco’s Andina Operation is between 3200 m and

4500 m and therefore medical assessment is performed by Codelco on every person working at the mine annually.

De-identified group data collected during 2018 on approximately 1622 full-time employees was provided by

Codelco to UOW in Microsoft Excel format and included parameters pertaining to the following non-communicable

disease risk factors:

Overweight and obesity;

Blood pressure;

Blood glucose; and

Cholesterol.

For purposes of comparison, Codelco group population data for each of the above parameters was compared to

the corresponding Chilean adult population data, maintained by the World Health Organisation (WHO 2008, WHO

2014, WHO 2015b, WHO 2015c, WHO 2016c).

5 RESULTS

Analysis of 242 questionnaires and 40 face-to-face interviews was performed to gain an understanding of the

extent of overweight, obesity and physical activity in the study population and contextualise the social,

environmental and cultural variables that influence such health outcomes (Ivankova et al. 2006).

De-identified group medical surveillance data was reviewed to compare non-communicable disease risk factors in

the study population with the Chilean adult population (WHO 2016d). The results of such comparison were used

to support identified themes relevant to the research and determine suitable interventions or recommendations to

support improved health outcomes in Chilean mine workers.

This results section has been structured to provide the reader with an understanding of the following key themes

from the analysis:

Research population health status;

Participants perception of own health status;

The value placed on health;

Personal health and impact of family life and employment; and

Workplace health promotion programs.

The terms used in this section of the report are:

23

Research Participant – A person recruited into this study and who participated in the questionnaire (n =

242);

Interview Participant – A person recruited into this study and who participated in a face to face interview

(n = 40); and

Study Population – A person employed by Codelco Andina and participated in an occupational medical

examination in 2018 (n = 1622).

5.1 Study Population

A total of 242 persons were recruited into the study. Participant ages ranged between 24 years and 69 years with

a mean age of 45 years (Figure 4).

Figure 4 – Participant Age

The duration of participant employment with Codelco Andina ranged between 1 year and 49 years with a mean of

16 years (Figure 5).

0%

10%

20%

32%

29%

8%

< 20 >20 <30 >30 <40 >40 <50 >50 <60 > 60

PARTI C I PANT AG E D I STRI BUTION ( YEARS)

24

Figure 5 – Duration of Employment with Codelco Andina

The majority of participants (64%) had no supervisory responsibilities. The remaining 36% were responsible for

the supervision of others at Codelco Andina with the majority being Team Leaders (Figure 6).

Figure 6 – Level of Supervisor Responsibility

5.2 Research Population Health Status

The mean BMI of Codelco’s Andina population is 27.8 kg/m2 with 80.6% of employees classified as overweight or

obese. Such results are commensurate with the mean BMI (28 kg/m2) of the general Chilean adult population.

Further examination of both Andina and Chilean Adult population data (Figure 7), in particular the percentage

distribution of each population in each BMI category suggests the prevalence of overweight and obesity in

Codelco’s Andina population is less than that observed in the general Chilean adult population, with the exception

of those classified with a "Normal” BMI.

11%

25%

21%

3%

21%

17%

2%

<5 >5 < 10 >10 <15 >15 <20 >20 <30 > 30 > 40

DURATI O N O F EM PLOYMENT ( YEARS)

64%

18%13%

4%0%

No supervisoryresponsibility

Team Leader Supervisor Manager Execuitive

PO SI T ION I N O RG ANI SATI O N

25

Figure 7 – Prevalence of Overweight and Obesity

(WHO 2016a)

Other non-communicable disease risk factors in Codelco’s Andina population were compared to the general

Chilean adult population including blood pressure, fasting blood glucose and total cholesterol.

Comparison of all parameters indicated Codelco’s Andina population had a reduced prevalence of elevated blood

pressure (Figure 8), elevated fasting glucose (Figure 9) and elevated cholesterol (Figure 10) when compared to

the general Chilean adult population. Additionally, the mean systolic blood pressure in Codelco’s Andina

population (116 mmHg) is lower than the general Chilean adult population (124 mmHg) (Figure 11).

0.70%8.20%

63.1%

28.0%

0.6%

18.90%

56.2%

24.4%

U N D E R W EI G H T( B MI < 1 8 )

N O R MA L( B MI 1 8 - 2 4 . 9 )

O V E R W EI G H T ( B MI ≥ 2 5 )

O B E S E ( B MI ≥ 3 0 )

PO

PU

LA

TIO

N P

RE

VE

LA

NC

E (

%)

PREVALENCE OF OVERWEIGHT AND OBESITY

Chilean Population Codelco Andina

26

Figure 8 – Prevalence of Raised Blood Pressure

(WHO 2015c)

Figure 9 – Elevated Fasting Blood Glucose

(WHO 2014)

Figure 10 – Prevalence of Elevated Cholesterol

(WHO 2008)

Figure 11 – Mean Systolic Blood Pressure

(WHO 2015b)

20.9

%

4.9

%

R AI S E D B P ( S B P ≥ 1 4 0 O R D B P ≥ 9 0 )

PO

PU

LA

TIO

N P

RE

VE

LA

NC

E (

%)

PREVALENCE OF RAISED BLOOD PRESSURE

(SYSTOLIC AND DIASTOLIC)


10.5

%

2.8

%

E L E V ATE D F AS TI N G B L O O D G L U C O S E ( ≥ 1 2 6 M G / D L )

PO

PU

LA

TIO

NP

RE

VE

LA

NC

E(%

)

ELEVATED FASTING BLOOD GLUCOSE


48.6

%

12.9

0%2

8.3

%

3.1

%

E L E V ATE D TO TAL C H O L E S TE R O L ( ≥ 5 . 0 M M O L /L )

E L E V ATE D TO TAL C H O L E S TE R O L ( ≥ 6 . 2 M M O L /L )

PO

PU

LA

TIO

N P

RE

VE

LA

NC

E (

%)

PREVALENCE OF ELEVATED TOTAL CHOLESTEROL


124 m

mH

g

116 m

mH

g

M E AN S YS TO L I C B P ( M M H G )

MEAN SYSTOLIC BLOOD PRESSURE


27

5.3 Perceived Health

When asked about their personal health status, 92% of participants viewed their health as good or better (Figure

12). This finding was echoed by the participants interviewed, with most (n=31) reporting a good health status,

appropriate for their age.

Figure 12 – Self-Reported Health Status

In some cases (n=9) interview participants acknowledged that their health or fitness could be better and needed

more self-care or exercise. Such was further reinforced by questionnaire respondents, of which only 37% reported

to be achieving the minimum recommended requirements for physical activity. Similarly, only 31% reported to

achieve the minimum recommended fruit and vegetable intake.

Perceptions of health and the actual health of the research population presents an interesting contradiction, as

while the participants report they are healthy, most (80.6%) are overweight or obese and a significant proportion

report inadequate physical activity (63%) and dietary nutrition (69%). As discussed previously, such risk factors

increase the likelihood of chronic diseases already experienced by some of the research population including

elevated blood sugar (12%), hypertension (13%) and elevated cholesterol (19%) (Figure 13).

14%

34%

44%

7%

1% 0%0%

10%

20%

30%

40%

50%

Excellent Very Good Good Fair Poor Don’t Know/ Not Sure

SELF - REPORTED G ENERAL HEALTH

28

Figure 13 – Prevenance of Chronic Disease

The disparity between perceived health and actual health is an interesting observation and warrants further

investigation to explain why such exists. One theory may be that the study population are self-rating their health

by comparing themselves against the general Chilean population, of which 73% self-rate their health as “good”

(Vincens et al, 2018). One other theory, is the deep-rooted relationship between social determinants and health,

in particular the observable relationship between those with higher incomes self-reporting better levels of health

when compared to those with lower incomes (Vincens et al, 2018, Mansyura et al, 2008, Reche et al, 2019). It

should be noted that both theories were not identified during the research, however have been presented to

highlight social and cultural factors that have the potential to influence perceived health status.

5.4 Value Placed on Good Health

Interview participants reported that “health” was comprised of three key elements: physical, psychological and

social (a strong connection with family and life outside of work), and when combined afforded the continued ability

to work.

The need to look after personal well-being now in order to protect future employment was identified as an important

value. Participants reported that they needed to embrace a lifestyle that didn’t impact their immediate health in

order to maintain their current employment. This value appeared to positively translate into the research

participants’ work life with 5% of respondents reporting they experienced difficulty accomplishing work tasks due

to health concerns (Figure 14).

0%

5%

10%

15%

20%

25%

Elevated BloodSugar/

Diabetes

Hypertension ElevatedCholesterol

Low BackDisorder

Anxiety/Depression

HEALTH R I SK FACTO RS

% Diagnosed % Taking Medication

29

Figure 14 – Difficulty Accomplishing Work Tasks Due to Health

Interview participants were identified to be clearly “future focussed” on aspects of their ongoing health and well-

being for the benefit of both the participants and their families, such is further discussed in the following section.

When questioned in regards to balancing the demands of work with family obligations, 82% of research

participants reported low conflict when managing the demands of work with their demands of their personal lives.

Health and Impact on Family Life

Some (n=8) interview participants reported no current family issues. However, for those expressing issues, two

main concerns were identified. First, a genuine concern regarding future uncertainty, even though things were

reported to be okay at present, there was significant value placed on ensuring things were “looked after” now to

mitigate problems in the future. Second, concern associated with bringing home negative aspects of work that

obstruct short term family connection. Such negative aspects included mood and irritability, along with general

tiredness, illness and muscular issues that prevented them from physically playing with their children.

Work related issues that impacted the participants’ connection and interaction with their immediate and extended

families was identified as important to most interview participants, with a number of participants reporting their

families often worried about them being injured at work, citing such to be a psychological burden.

Employment and Impact on Health

Somewhat surprisingly after the majority of interviewed participants’ self-reported good health, was that the

majority also believed that working conditions did affect their health in some way. Upon further questioning

interview participants elaborated and described numerous factors associated with work that had affected their

health. Factors included travelling to and from work, distances covered in a work day, stress and mental fatigue,

muscular pain, silica exposure and silicosis, colds and flu, weight concerns, sedentary work, sleep problems,

allergies and skin issues.

Many interview participants noted and accepted a decline in their health and fitness with age, specifically

describing deterioration in joints, muscles, being worn out physically and issues associated with working at altitude.

Significantly, many also believed that their health has remained the same as when they started with the company.

When asked about job demands, 53% of research participants reported high physical demands while 83% reported

high emotional demands. Such demands however are opposed by reported high supervisor and co-worker

support, along with high decision authority and skill discretion (Figure 15).

0%

10%

20%

30%

40%

50%

60%

70%

StronglyDisagree

Disagree Neutral Agree StronglyAgree

HEAL TH I NTERF ERENCE W I TH W O RK

30

Figure 15 – Psychosocial Work Environment Demands, Support, Security and Use of Skills

5.5 Desire for Change

Commuting Between Home and Work

Interview participants were invited to suggest work conditions, that if modified would benefit them in the future.

The majority of responses focussed upon travelling between their home and the work place, especially the

distances and time involved, compounded by the shift patterns which they worked. Such findings were further

reinforced in the questionnaire responses with 59% of research participants reporting commute durations greater

than 90 minutes (Figure 16). This aspect is important for consideration as, for example, leaving very early and

getting home very late would be linked with an employee’s inability to exercise and perform adequate personal

care, along with interacting and spending quality time with their families.

Figure 16 – Daily Commute Duration

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

PhysicalJob

Demands

JobDemands

EmotionalDemands

DecisionAuthority

CoworkerSupport

SupervisorSupport

SkillDiscretion

JobSecurity

PSYCHO SOCIAL W O RK ENVI RONMENT

0%

10%

20%

30%

40%

50%

60%

70%

15 minutes 15 - 30 minutes 30 - 60 minutes 60 - 90 minutes > 90 minutes

CO M MUTE DURATI O N

31

Workloads and the Work Environment

Modifying workloads and experiences at work was suggested by a small number of interviewee’s (n=7), and

therefore was not a strong and reoccurring theme. With regards to shift patterns and shift duration, issues

associated with such were related to travel and the distances between home and work, rather than the roster

arrangement itself.

Interestingly and of note, 89% of research participants reported satisfaction with their job (Figure 17), which is an

important aspect as it significantly influences emotional wellbeing and commitment to work. However, 10% of

research participants reported they intended to leave their job, indicating disengagement and potential negative

impact on wellbeing and productivity (Figure 17).

Figure 17 – Job Satisfaction and Intention to Leave

Concern specifically associated with being female in a male dominated workplace was raised (n=2), however due

to the low proportion of female interview participants (8%), such concern was not repeated however has been

included in this research report as mutual respect and regard for others influence the quality of work life. Such was

further reflected by the research participants with less than half (45%) reporting a fair and just workplace2 (Figure

18) while 63% reported the workplace to be civil3 and respectful.

2 Justice – refers to employee perceptions of fairness in how organisational procedures which affect employee wellbeing and quality of work life are applied. 3 Civil Norms – refers to tolerance of behaviors that violate unspoken rules of mutual respect, courtesy, regard for others.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Job Satisfaction Intention to Leave

JO B SATI SFACTI O N

32

Figure 18 – Justice and Civil Norms

Desire to Change

Interview participants were asked about their future health intentions. Most (n=28) reported a desire to change

their diet, meal quality, nutrition and weight. Such desire to adopt a healthier lifestyle was reflected in the

questionnaire responses where a significant proportion of the research participants indicated they had considered

or were ready to change a range of health behaviours, in particular weight loss (70%), physical activity (71%)

eating habits (73%) and stress reduction (70%) (Figure 19).

Figure 19 – Motivation to Adopt Healthier Lifestyles

Participant interviews (n=16) revealed that Codelco Andina had addressed the issue of eating habits through

targeted programs that included consultation and employee input into the meals provided at work, however the

participant responses with respect to their desire to change was indicated to be a desire to take charge of their

own outcomes, rather than that provided by the company.

0%

10%

20%

30%

40%

50%

60%

70%

Justice Civil Norms

W O RKPLACE AUTO NO M Y

0%

20%

40%

60%

80%

100%

PhysicalActivity

EatingHabits

Tobacco Use Lose Weight ReduceStress

ImproveSleep

ReduceAlcohol

READI NESS FO R CHANG E

Actively Changing Ready Considered

33

5.6 Organisational Support

Interview participants were questioned with regards to the commitment of the company and its leadership towards

workers health. Participants generally believed their supervisors demonstrated a commitment to their health, with

the caveat that the focus was on work-related safety rather than on the broader implications of physical and

psychological well-being. Questionnaire responses further reinforced such findings with 83% of research

participants reporting a safe workplace, including safety initiatives targeted at safe work practices, while only 21%

of respondents reported organisational support4 for initiatives that target healthy behaviours. There is a genuine

opportunity for Codelco to be more pro-active by embedding health initiatives in conjunction with existing safety

programs.

Opportunities provided by Codelco Andina for employees to maintain or improve their health at work indicated a

priority for tobacco control (56%), followed by healthy eating (49%), physical activity (37%) and stress

management (23%) (Figure 20).

Figure 20 – Health Opportunities at Work

Participants generally had some awareness of health-related company policies and programs, especially in the

areas of drugs and alcohol, diet and weight loss. However, many (n=16) reported that they chose not to participate,

primarily due to the timing of the program delivery, citing long work days, particularly when travel was involved, or

because they didn’t feel the need for such programs at the time.

Worker Consultation

Interview participants were questioned regarding worker consultation and involvement in identifying opportunities

to improve workplace conditions that affect health outcomes. Responses differed as some participants believed

while employees were consulted (n=10), such consultation failed to include any follow up (n=5). Almost half of

participants were of the opinion that employees were not consulted (n=19), while a significant proportion believed

the company only acted through the unions (n=22).

4 Organisational Support – refers to company initiatives implemented to support healthy behaviors in employees.

0%

10%

20%

30%

40%

50%

60%

Physical Activity Healthy Eating Tabacco Control StressManagement

HEALTH O PPO RTUNIT I ES AT W O RK

34

Questionnaire responses regarding a supportive health climate5 indicated 46% of respondents believed Codelco

Andina provided opportunities and resources to be healthy, indicating a similar differing awareness of systems

intended to facilitate the improvement of health outcomes.

Interview participants indicated interventions targeting employee diet and exercise is understood to have mixed

results, regardless considerable employee goodwill was observed and could contribute to successful outcomes if

applied towards a well-designed intervention. The observation that some of the company interventions have not

necessarily been well supported or received may be because of design and implementation rather than a lack of

employee desire.

Interview participants reported that more could be done by the company in terms of employee involvement to

identify opportunities for improvements, citing that sometimes ideas were collected but not acted upon, and in

some cases participants felt that they were informed rather than consulted.

Supervisor Resources

Mixed findings were recorded regarding the interview participants’ perception of resources available to supervisors

to be effective in protecting and promoting the safety, health, and welfare of workers. Again, there was a general

consensus that resources made available to supervisors were focused on workplace safety and accident

prevention, rather than an intention for use to improve employee health and well-being. It was acknowledged that

supervisors often were occupied with matters related to work and therefore prevented attention given to worker

health outcomes.

6 CONCLUSIONS

This research project comprises of two main components. Firstly, a review of the current body of knowledge on

the effectiveness of workplace health promotion interventions. Secondly, population data that was collected and

analysed from a representative Chilean mine operation.

This section of the report outlines the findings of those research activities.

6.1 Literature

A significant amount of research reported in the literature has been conducted on workplace interventions targeting

overweight and obesity among employees. However, most of these studies have been conducted in developed

countries and in workplaces with reliable support systems, therefore, findings may not be applicable to developing

countries (Mattke et al. 2013).

Evidence of Intervention Effectiveness

Evidence for actual effectiveness of health promotion interventions demonstrated positive effects on diet and

exercise, smoking, alcohol use and health care costs. There was limited impact on absenteeism and mental

health.

However, the usefulness of this ‘evidence’ has been criticised as anecdotal and inconclusive as many interventions

lacked rigorous evaluation (Mattke et al. 2012). Any positive effects observed were more likely to be associated

with the intensity of the intervention itself (Mattke et al. 2012).

5 Supportive Health Climate – refers to the extent of which employees are aware of social support networks and practices that promote and maintain improved health behaviors.

35

Additionally, the abundance of literature only encompassed a minor proportion of interventions and prompted

questions regarding the generalisability of reported findings, particularly in developing countries and in

subpopulations (Mattke et al. 2012).

Studies relevant to the effectiveness of health promotion interventions implemented in the mining industry were

not identified in any of the sources, nor were studies relevant to the Chilean working population, therefore

reinforcing the priority for research efforts.

Intervention Strategies

The literature review identified a need to evaluate the impact of workplace health interventions in “real world”

settings to better inform decision making and improve health outcomes at workplaces.

The “Total Worker Health” (TWH) framework and supporting theoretical knowledge aims for successful and

sustainable interventions by integrating health promotion into exisiting workplace policies, programs and practices

(Seabury et al. 2005). The suitability of the framework in ‘real world’ settings is appropriate as it can be adapted

to accommodate the social norms and cultural influences relevant to the target country (Sorensen et al. 2016a).

The TWH framework was identified as a method suitable for use in the occupational environment to improve

worker’s nutrition and physical activity-related behaviours and decrease musculoskeletal injuries in Chilean mine

workers.

A summary and conclusion regarding current literature is provided in Table 9.

Table 9 – Conclusion: Literature Regarding the Effectiveness of Health Promotion Interventions

SUMMARY:

The majority of literature has been published by developed countries.

The literature only covers a small proportion of interventions, preventing the translation

of results, particularly in developing countries and in subpopulations.

Intervention intensity was identified as a confounder, influencing intervention

effectiveness.

Conclusive health promotion research requires greater rigorous evaluation, such that

policymakers are informed when making decisions and to improve health outcomes.

The Total Worker Health framework can be applied to guide research methods to

evaluate the impact of workplace health interventions in “real world” settings.

CONCLUSION:

Conclusive health promotion literature, particularly regarding the Chilean working

population is deficient. Therefore, research regarding the design, testing and evaluation

of workplace interventions relevant in the Chilean context should be prioritised.

The Total Worker Health framework is suggested for use to guide such research.

6.2 Research Population

Results of the research demonstrated a significant proportion of the research population is overweight or obese

(80.6%) and is consistent with prevalence in the general Chilean adult population (91%).

Comparison of other non-communicable disease risk factors demonstrated the research population had a reduced

prevalence of elevated blood pressure, elevated fasting glucose and elevated cholesterol when compared to the

general Chilean adult population. Additionally, the mean systolic blood pressure in the research population is

slightly lower than the general Chilean adult population. It should be noted that although the results of such risk

factors are considered marginally better, they are not statistically significant.

36

One possible explanation for this observation is the requirement for all persons who work at the Andina Mine to

comply with established medical criteria and demonstrate on an annual basis that they are fit for their role and

continued occupational altitude exposure (Chilean Ministry of Health, 2020). It should be noted that this

relationship was not identified during the research, however is suggested to highlight a potential positive

relationship between occupational fitness requirements and preventing the progression of non-communicable

disease risk factors over time.

The perceived health and the actual health of the research population presented an interesting contradiction, as

the research population believe they are healthy, although the majority are overweight or obese and report

inadequate physical activity and dietary nutrition. This perception is incongruent with measured health outcomes,

in particular those risk factors that promote non-communicable disease.

Such a contradiction was an interesting study observation and warrants further investigation to explain why. One

supposition may be that the study population are self-rating their health by comparing themselves against their

peers in the general Chilean population. Alternately, this could be due to the deep-rooted relationship between

social determinants and health, in particular the observable relationship between those with higher incomes self-

reporting better levels of health when compared to those with lower incomes (Vincens et al, 2018, Mansyura et al,

2008, Reche et al, 2019). While neither of these suppositions were tested or identified during the research, they

have been presented to highlight social and cultural factors that have the potential to influence perceived health

status.

A summary and conclusion regarding the health status of the research population is provided in Table 10.

Table 10 – Conclusion: Health Status of the Research Population

SUMMARY:

Majority of the research population believe they are healthy, despite a significant

proportion being overweight or obese and reporting inadequate physical activity and

dietary nutrition.

The prevalence of overweight and obesity in the research population is commensurate

with the general Chilean adult population.

Non-communicable disease risk factors were observed to be slightly lower in the

research population when compared to the general Chilean adult population.

CONCLUSION: The perceived health of the research population is incongruent with measured non-

communicable disease risk factors.

6.2.1 Health Beliefs and Attitudes

Value Placed on Health and Desire to be Healthy

Good health was observed to be valued significantly as it is believed to be a fundamental and inherent enabler for

continued participation in work. This observation ironically mirrors the underpinning principle of the Ottawa Charter,

that is health is a “resource for everyday life, not the object of living” (WHO 2016c).

The research population were clearly “future focussed” citing the ability to work afforded both themselves and their

families’ greater benefits and an ability to prepare for future uncertainty. This value and belief translates into a

genuine desire to be healthy.

The strong connection between “being healthy” and protecting future employment was contrasted by the

identification of numerous work related factors that had impacted the health of the research population. Factors

included travelling to and from work, distances covered in a work day, stress and mental fatigue, muscular pain,

37

silica exposure and silicosis, colds and flu, weight concerns, sedentary work, sleep problems, allergies and skin

issues.

Maintaining a connection with immediate and extended family members was identified as an important value.

Issues compromising this desired connection were identified to include mood and irritability, along with general

tiredness, illness and muscular issues that prevented physical play with children.

A summary and conclusion regarding the health beliefs and attitude of the research population is provided in Table

11.

Table 11 – Conclusion: Health Beliefs and Attitudes

SUMMARY:

The research population are focused on the future of themselves and their families

Health is believed to be a fundamental and inherent enabler for continued participation

in work

Work related factors were identified to impact both health and family connection

CONCLUSION: The research population genuinely desire to be healthy and place great value on the

benefits of being healthy.

6.3 Organisation Health Promotion

Worker Consultation and Input

Codelco Andina have implemented a number of health promotion programs, in particular those that target tobacco

use, drugs, alcohol, diet and weight loss. The design of such programs however, involved less than desired worker

consultation and subsequently once implemented, were not well supported or received, primarily due to the due

to the timing of the program delivery, not because of the intervention itself.

Balancing the demands of long work days against a willingness to participate in health improvement activities is

not only the challenge, however presents an opportunity. Considerable goodwill was observed in the research

population which may result in successful outcomes if applied to an intervention designed with worker consultation

and input.

Commuting Between Home and Work

Daily commute durations between home and work, and vice-versa was identified as the most significant issue for

the majority of the research population, particularly where such was compounded by 12 hour shift patterns. This

issue is important when considering the impact on worker health. While the research recognises commute

activities inherently do not directly cause adverse health, it does however influence the workers opportunity to

participate in health promoting activities such as exercise, personal care and spending quality time with their family.

The relationship between long work days (particularly where travel is involved) and each workers opportunity to

rest and recover provides greater context for the less than desirable participation in company health promotion

programs and was reinforced by the research.

Organisational Support

The company and its supervisors demonstrate a genuine commitment to the health of its workers, however such

is caveated by a focus on work-related safety rather than on the broader implications of physical and psychological

well-being.

The research population are mature in their understanding of the relationship between their work environment and

their physical and psychological well-being. They demonstrate genuine support for their supervisors and a

38

willingness to be involved in programs that suit both their needs and their availability, taking into account the

peculiar challenges of working at altitude and some distance from their homes. This should allow the company to

integrate all of this into a comprehensive system that looks at both the present, with an emphasis on safety, and

the future, with an emphasis on long term health and well-being.

A summary and conclusion regarding company health promotion programs is provided in Table 12.

Table 12 – Conclusion: Organisational Health Promotion

SUMMARY:

The support of historical company interventions may be because of the design and

implementation rather than a lack of employee desire.

Long commute durations significantly encroach workers opportunity to participate in

health promoting activities

Health programs are eclipsed by workplace safety programs and are therefore not

considered to be a priority

CONCLUSION:

Existing and well-known issues are actually opportunities for company improvement,

however such improvements fundamentally rely on genuine company consultation with

its workforce to seek input and collectively identify solutions appropriate to both parties.

6.4 Recommendations

The research revealed opportunities for improvement that can be targeted at the local research site, the wider

Codelco Company and nationally and are presented below:

Codelco Andina

Communicate the results of this research with workers and Codelco Andina;

Apply the results of this research to identify existing systems of work that can be tailored to include

health promotion interventions, rather than establishing stand-alone health programs;

Establish standardised methods for worker consultation and input into health promotion programs such

that programs are co-designed and co-implemented;

Continue to collect de-identified medical surveillance data; and

Analyse and review such data periodically to better understand the health of the research population

over time.

Codelco

Communicate the results of this research in Codelco;

If not already performed, centralise the de-identified medical surveillance data for the entire Codelco

working population; and

If not already performed, analyse and review such data periodically to better understand the health of

the Codelco working population over time and to identify opportunities for companywide improvement.

Chile

Communicate the results of this research for purposes of promoting knowledge of methods that can be

applied to identify suitable workplace health promotion interventions;

Develop and validate instruments for use by Chilean employers that facilitate the identification of suitable

health promotion interventions; and

39

Prioritise research regarding the design, testing and evaluation of workplace interventions relevant in the

Chilean context.

6.5 Limitations

Research interviews are a small sample (n=40) of the total research participant (n=242) sample. The number of

interviews, although smaller than the number of research participants, is still considered sufficiently large to have

addressed the main issues and themes relevant to the research population (Saunders et al., 2018). The interview

questions were mostly followed and then elaborated upon, however, there were instances where the wording was

slightly changed in order to make meaning for the interviewee, and also a few instances where certain questions

were omitted. None of these instances are thought to have detracted from the overall body of results generated.

40

7 REFERENCES

ABS 2008, Overweight and Obesity in Adults, Australia, 2004-05, Australian Bureau of Statistics, viewed

October 2 2016, http://www.abs.gov.au/ausstats/[email protected]/Latestproducts/4719.0Main%20Features32004-

05?opendocument&tabname

Agampodi, T.C., Agampodi, S.B., Glozier, N. and Siribaddana, S., 2015. Measurement of social capital in

relation to health in low and middle income countries (LMIC): a systematic review. Social Science &

Medicine, 128, pp.95-104.

Albala, C., Vio, F., Kain, J. & Uauy, R. 2002, ‘Nutrition transition in Chile: determinants and consequences’,

Public Health Nutrition, vol. 5, no. 1a, pp. 123-128.

Anandacoomarasamy, A., Caterson, I., Sambrook, P., Fransen, M. & March, L. 2008, ‘The impact of

obesity on the musculoskeletal system’, International Journal of Obesity, vol. 32, no. 2, pp. 211-222.

Anger, W.K., Elliot, D.L., Bodner, T., Olson, R., Rohlman, D.S., Truxillo, D.M., Kuehl, K.S., Hammer, L.B. &

Montgomery, D. 2015, ‘Effectiveness of Total Worker Health interventions’, Journal of Occupational Health

Psychology, vol. 20, no. 2, pp. 226-247.

Batt, M.E. 2009, ‘Physical activity interventions in the workplace: the rationale and future direction for

workplace wellness’, British Journal of Sports Medicine, vol. 43, no. 1, pp. 47-48.

Baum, F. 2008, The New Public Health, 3 edn, Oxford University Press, South Melbourne, Victoria.

Baum, F. 2011, ‘From Norm to Eric: avoiding lifestyle drift in Australian health policy’, Australian and New

Zealand Journal of Public Health, vol. 35, no. 5, pp. 404-406.

Baum, F. & Sanders, D. 1995, ‘Can health promotion and primary health care achieve health for all without

a return to their more radical agenda?’, Health Promotion International, vol. 10, no. 2, pp. 149-160.

Berelson, B. (1952). Content analysis in communication research. New York: Hafner.

Bully, P., Sánchez, Á., Zabaleta-del-Olmo, E., Pombo, H. & Grandes, G. 2015, ‘Evidence from

interventions based on theoretical models for lifestyle modification (physical activity, diet, alcohol and

tobacco use) in primary care settings: A systematic review’, Preventive Medicine, vol. 76, Supplement, pp.

S76-S93.

Celis-Morales, C., Salas, C., Alduhishy, A., Sanzana, R., Martínez, M.A., Leiva, A., Diaz, X., Martínez, C.,

Álvarez, C. & Leppe, J. 2016, ‘Socio-demographic patterns of physical activity and sedentary behaviour in

Chile: results from the National Health Survey 2009–2010’, Journal of Public Health, vol. 38, no. 2, pp. e98-

e105.

Chilean Ministry of Health. 2020, Guía Técnica: Sobre Exposición Ocupacional a Hipobaria Intermitente

Crónica Por Gran Altitud, Departamento de Salud Ocupacional, viewed May 11 2020,

https://www.minsal.cl/sites/default/files/guia_hipobaria_altitud.pdf

Christakis, N.A. & Fowler, J.H. 2007, ‘The spread of obesity in a large social network over 32 years’, New

England Journal of Medicine, vol. 357, no. 4, pp. 370-379.

CPH-NEW. 2014, Healthy Workplace All Employee Survey, Center for Promotion of Health in the New

England Workplace, viewed August 22 2019, https://www.uml.edu/docs/AES_manual_4-17-14_tcm18-

147260.pdf

http://www.abs.gov.au/ausstats/[email protected]/Latestproducts/4719.0Main%20Features32004-05?opendocument&tabname

http://www.abs.gov.au/ausstats/[email protected]/Latestproducts/4719.0Main%20Features32004-05?opendocument&tabname

https://www.minsal.cl/sites/default/files/guia_hipobaria_altitud.pdf

https://www.uml.edu/docs/AES_manual_4-17-14_tcm18-147260.pdf

https://www.uml.edu/docs/AES_manual_4-17-14_tcm18-147260.pdf

41

Doiron, D., Fiebig, D.G., Johar, M. and Suziedelyte, A., 2015. Does self-assessed health measure health?.

Applied Economics, 47(2), pp.180-194.

Gazmararian, J.A., Elon, L., Newsome, K., Schild, L. & Jacobson, K.L. 2013, ‘A randomized prospective

trial of a worksite intervention program to increase physical activity’, American Journal of Health Promotion,

vol. 28, no. 1, pp. 32-40.

Grunseit, A.C., O’Hara, B.J., Chau, J.Y., Briggs, M. & Bauman, A.E. 2015, ‘Getting the Message Across:

Outcomes and Risk Profiles by Awareness Levels of the “Measure-Up” Obesity Prevention Campaign in

Australia’, PLoS One, vol. 10, no. 4.

Hancock, T. 2007, ‘Creating Environments for Health – 20 Years On’, Promotion & Education, vol. 14, no.

s2, pp. 7-8.

Health, H.S.o.P. 2016, The Nutrition Transition, Harvard School of Public Health, viewed September 30

2016, https://www.hsph.harvard.edu/obesity-prevention-source/nutrition-transition/

Hopkins, J.M., Glenn, B.A., Cole, B.L., McCarthy, W. & Yancey, A. 2012, ‘Implementing organizational

physical activity and healthy eating strategies on paid time: Process evaluation of the UCLA WORKING

pilot study’, Health Education Research, vol. 27, no. 3, pp. 385-398.

Hunt, K. & Emslie, C. 2001, ‘Commentary: The prevention paradox in lay epidemiology – Rose revisited’,

International Journal of Epidemiology, vol. 30, pp. 442-446.

ILO 2012, A comprehensive approach to improving nutrition at the workplace: A survey of Chilean

companies and tailored recommendations, International Labour Organization, Geneva, Switzerland.

Kickbusch, I. 2007, ‘The Move Towards a New Public Health’, Promotion & Education, vol. 14, no. 2, p. 9.

Kickbusch, I. 2015, ‘The imperative of public health: opportunity or trap?’, Health Promotion International,

vol. 30, no. 2, pp. 197-200.

King, E., Grunseit, A., O’Hara, B. & Bauman, A. 2013, ‘Evaluating the effectiveness of an Australian obesity

mass-media campaign: how did the ‘Measure-Up’ campaign measure up in New South Wales?’ Health

education research, vol. 28, no. 6, pp. 1029-1039.

Labonté, R. 2011, ‘Toward a post-Charter health promotion’, Health Promotion International, vol. 26, no.

suppl 2, pp. ii183-ii186.

Mansyur, C., Amick, B.C., Harrist, R.B. and Franzini, L., 2008. Social capital, income inequality, and self-

rated health in 45 countries. Social Science & Medicine, 66(1), pp.43-56.

Mattke, S., Liu, H., Caloyeras, J.P., Huang, C.Y., Van Busum, K.R., Khodyakov, D. & Shier, V. 2013,

Workplace wellness programs study.

Mattke, S., Schnyer, C. & Van Busum, K. 2012, A review of the US workplace wellness market,

083307721X, Rand Health.

Méndez, J. 2018. Health evaluation for occupational high-altitude exposure: results from a Chilean copper

mine during 2016. Occupational and Environmental Medicine, 75 (Suppl_2).

Michaels, C.N. & Greene, A.M. 2013, ‘Worksite Wellness: Increasing Adoption of Workplace Health

Promotion Programs’, Health Promotion Practice, vol. 14, no. 4, pp. 473-479.

https://www.hsph.harvard.edu/obesity-prevention-source/nutrition-transition/

42

NIOSH 2008, Essential elements of effective workplace programs and policies for improving worker health

and wellbeing, U.S Department of Health and Human Services, viewed September 16 2016,

http://www.cdc.gov/niosh/twh/essentials.html

Osilla, K.C., Van Busum, K., Schnyer, C., Larkin, J.W., Eibner, C. & Mattke, S. 2012, ‘Systematic review of

the impact of worksite wellness programs’, American Journal of Managed Care, vol. 18, no. 2.

Østbye, T., Stroo, M., Brouwer, R.J.N., Peterson, B.L., Eisenstein, E.L., Fuemmeler, B.F., Joyner, J.,

Gulley, L. & Dement, J.M. 2013, ‘The steps to health employee weight management randomized control

trial: Rationale, design and baseline characteristics’, Contemporary Clinical Trials, vol. 35, no. 2, pp. 68-76.

Reche, E., König, H.H. and Hajek, A., 2019. Income, Self-Rated Health, and Morbidity. A Systematic

Review of Longitudinal Studies. International Journal of Environmental Research and Public Health, 16(16),

p.2884.

Ridde, V., Guichard, A. & Houeto, D. 2007, ‘Social inequalities in health from Ottawa to Vancouver: action

for fair equality of opportunity’, Promotion & Education, vol. 14, no. S2, pp. 12-16.

Rongen, A., Robroek, S.J.W., van Lenthe, F.J. & Burdorf, A. 2013, ‘Workplace Health Promotion: A Meta-

Analysis of Effectiveness’, American Journal of Preventive Medicine, vol. 44, no. 4, pp. 406-415.

Rose, G. 2001, ‘Sick individuals and sick populations’, International Journal of Epidemiology, vol. 30, no. 3,

pp. 427-432.

Rydin, Y., Bleahu, A., Davies, M., Dávila, J., Friel, S., De Grandis, G., Groce, N., Hallal, P., Hamilton, I.,

Howden-Chapman, P., Lai, K., Lim, C., Martins, J., Osrin, D., Ridley, I., Scott, I., Taylor, M., Wilkinson, P. &

Wilson, J. 2012, ‘The Lancet Commissions: Shaping cities for health: complexity and the planning of urban

environments in the 21st century’, The Lancet, vol. 379, pp. 2079-2108.

San Martin, R., Brito, J., Siques, P. and León-Velarde, F., 2017. Obesity as a conditioning factor for high-

altitude diseases. Obesity Facts, 10(4), pp.363-372.

Saunders, B. et al. (2018). Saturation in qualitative research: exploring its conceptualization and

operationalization. Qual Quant. 2018; 52(4): 1893–1907. Published online 2017 Sep 14. doi:

10.1007/s11135-017-0574-8

Seabury, S.A., Lakdawalla, D. & Reville, R.T. 2005, The economics of integrating injury and illness

prevention and health promotion programs, RAND Institute for Civil Justice.

Sorensen, McLellan, D.L., Sabbath, E.L., Dennerlein, J.T., Nagler, E.M., Hurtado, D.A., Pronk, N.P. &

Wagner, G.R. 2016a, ‘Integrating worksite health protection and health promotion: A conceptual model for

intervention and research’, Preventative Medicine, vol. 91, pp. 188-196.

Sorensen, G., Nagler, E.M., Hashimoto, D., Dennerlein, J.T., Theron, J.V., Stoddard, A.M., Buxton, O.,

Wallace, L.M., Kenwood, C., Nelson, C.C., Tamers, S.L., Grant, M.P. & Wagner, G. 2016b, ‘Implementing

an Integrated Health Protection/Health Promotion Intervention in the Hospital Setting Lessons Learned

From the Be Well, Work Well Study’, Journal of Occupational and Environmental Medicine, vol. 58, no. 2,

pp. 185-194.

Tamers, S.L., Beresford, S.A.A., Cheadle, A.D., Zheng, Y., Bishop, S.K. & Thompson, B. 2011, ‘The

association between worksite social support, diet, physical activity and body mass index’, Preventive

Medicine, vol. 53, no. 1-2, pp. 53-56.

http://www.cdc.gov/niosh/twh/essentials.html

43

Thorndike, A.N., Sonnenberg, L., Healey, E., Myint-U, K., Kvedar, J.C. & Regan, S. 2012, ‘Prevention of

weight gain following a worksite nutrition and exercise program: A randomized controlled trial’, American

Journal of Preventive Medicine, vol. 43, no. 1, pp. 27-33.

Vartiainen, E.A., Laatikainen, T., Philpot, B., Janus, E.D., Davis-Lameloise, N. & Dunbar, J.A. 2011, ‘The

projected impact of population and high-risk strategies for risk-factor control on coronary heart disease and

stroke events’, Medical journal of Australia, vol. 194, no. 1, pp. 10-15.

Vincens, N., Emmelin, M. and Stafström, M., 2018. Social capital, income inequality and the social gradient

in self-rated health in Latin America: A fixed effects analysis. Social Science & Medicine, 196, pp.115-122.

Vio, F., Albala, C. & Kain, J. 2008, ‘Nutrition transition in Chile revisited: mid-term evaluation of obesity

goals for the period 2000–2010’, Public Health Nutrition, vol. 11, no. 4, pp. 405-412.

Wakefield, M.A., Coomber, K., Durkin, S.J., Scollo, M., Bayly, M., Spittal, M.J., Simpson, J.A. & Hill, D.

2014, ‘Time series analysis of the impact of tobacco control policies on smoking prevalence among

Australian adults, 2001? 2011’, Bulletin of the World Health Organization, vol. 92, no. 6, pp. 413-422.

WHO 2008, Mean Total Cholesterol (age-standardized estimate) (25 years +), World Health Organisation,

visited 26 Septiembre 2019, https://www.who.int/data/gho/data/indicators/indicator-details/GHO/mean-total-

cholesterol-(age-standardized-estimate)

WHO 2014, Blood Glucose. Raised fasting (≥ 7.0 mmol/L or ≥ 126 mg/dL) (age-standardized), World

Health Organisation, visited 26 Septiembre 2019, https://www.who.int/data/gho/data/indicators/indicator-

details/GHO/raised-fasting-blood-glucose-(-=7-0-mmol-l-or-on-medication)(age-standardized-estimate)

WHO 2015a, Noncommunicable diseases: Fact Sheet, World Health Organisation, visited 4 May 2016,

http://gamapserver.who.int/gho/interactive_charts/ncd/risk_factors/physical_inactivity/atlas.html?detectflash

=false

WHO 2015b, Mean Systolic Blood Pressure (age-standardized estimate), World Health Organisation,

visited 26 September 2019, https://www.who.int/data/gho/data/indicators/indicator-details/GHO/mean-

systolic-blood-pressure-(age-standardized-estimate)

WHO 2015c, Raised Blood Pressure (SBP ≥ 140 or DBP ≥ 90) (age-standardized estimate), World Health

Organisation, visited 26 September 2019, https://www.who.int/data/gho/data/indicators/indicator-

details/GHO/raised-blood-pressure-(sbp-=140-or-dbp-=90)-(age-standardized-estimate)

WHO 2016a, Global Health Observatory (GHO) data: Noncommunicable diseases (NCD), World Health

Organisation, visited 4 May 2016, http://www.who.int/gho/ncd/en/

WHO 2016b, Health promotion: The Ottawa Charter for Health Promotion, World Health Organisation,

visited 13 March 2016, http://www.who.int/healthpromotion/conferences/previous/ottawa/en/

WHO 2016c, The workplace: A priority setting for health promotion, World Health Organisation, visited

October 2 2016, http://www.who.int/occupational_health/topics/workplace/en/

WHO 2016d, Global Health Observatory (GHO) data: Prevalence of underweight among adults, BMI <

18.5, age-standardized. Estimates by country, World Health Organisation, visited 26 September 2019,

https://apps.who.int/gho/data/node.main.NCDBMILT18A?lang=en

WHO 2020, Process of Translation and Adaptation of Instruments, World Health Organisation, visited 12

May 2020, https://www.who.int/substance_abuse/research_tools/translation/en/

https://www.who.int/data/gho/data/indicators/indicator-details/GHO/mean-total-cholesterol-(age-standardized-estimate)

https://www.who.int/data/gho/data/indicators/indicator-details/GHO/mean-total-cholesterol-(age-standardized-estimate)

https://www.who.int/data/gho/data/indicators/indicator-details/GHO/raised-fasting-blood-glucose-(-=7-0-mmol-l-or-on-medication)(age-standardized-estimate)

https://www.who.int/data/gho/data/indicators/indicator-details/GHO/raised-fasting-blood-glucose-(-=7-0-mmol-l-or-on-medication)(age-standardized-estimate)

http://gamapserver.who.int/gho/interactive_charts/ncd/risk_factors/physical_inactivity/atlas.html?detectflash=false

http://gamapserver.who.int/gho/interactive_charts/ncd/risk_factors/physical_inactivity/atlas.html?detectflash=false

https://www.who.int/data/gho/data/indicators/indicator-details/GHO/mean-systolic-blood-pressure-(age-standardized-estimate)

https://www.who.int/data/gho/data/indicators/indicator-details/GHO/mean-systolic-blood-pressure-(age-standardized-estimate)

https://www.who.int/data/gho/data/indicators/indicator-details/GHO/raised-blood-pressure-(sbp-=140-or-dbp-=90)-(age-standardized-estimate)

https://www.who.int/data/gho/data/indicators/indicator-details/GHO/raised-blood-pressure-(sbp-=140-or-dbp-=90)-(age-standardized-estimate)

http://www.who.int/gho/ncd/en/

http://www.who.int/healthpromotion/conferences/previous/ottawa/en/

http://www.who.int/occupational_health/topics/workplace/en/

https://apps.who.int/gho/data/node.main.NCDBMILT18A?lang=en

https://www.who.int/substance_abuse/research_tools/translation/en/

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CHILEAN MINE WORKER HEALTH - AIOH

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