The World Health Organization (WHO) has identified the workplace as a priority setting for health promotion, as it “directly influences the physical, mental, economic and social well-being of workers and in turn the health of their families, communities and society” [1]. Workplace health promotion (WHP) is understood to constitute “the combined efforts of employers, employees and society to improve the health and well-being of people at work” [2] and often converges in “multi-faceted initiatives to improve health in the workplace based on comprehensive health promotion programs” [2]. WHP and particularly behaviour-based prevention such as physical activity [3, 4] is one significant part of Occupational Health Management (OHM). Although no universally accepted definition of OHM exists, it typically includes legally mandated occupational health and safety, behaviour-oriented measures aimed at promoting well-being and health by encouraging individual employees to change their behaviour, and system-oriented measures aimed at improving working conditions and thereby contributing to a healthy workplace for all employees [5, 6].
A potentially relevant management framework for OHM is Corporate Social Responsibility (CSR), which “…is essentially a concept whereby companies decide voluntarily to contribute to a better society and a cleaner environment. […] This responsibility is expressed towards employees and more generally towards all the stakeholders affected by business and which in turn can influence its success” [7]. Generally speaking, CSR provides reasons for engaging in activities that transcend a company’s core financial goals. Although employee health and safety were not traditionally a central element of CSR, this view is increasingly being reconsidered on both the political and scientific levels. The European Agency for Safety and Health at Work published a report in 2004 on “Corporate social responsibility and safety and health at work” [8], and the “EU strategy 2011–14 for Corporate Social Responsibility” suggested linking the topics of CSR and health together, referring to “employee health and well-being” as an aside in its conceptualisation of CSR [7]. In the scientific literature, Zink has suggested that “the promotion of the positive image of health and motivation in a framework of corporate social responsibility […] is required” [9]. Kuhn and Gensch have also referred to the responsibility debate within CSR as providing an orientation for the topic of health promotion at work [10].
The legal framework in Germany regarding WHP provides an interesting example of the increasing overlap between OHM and CSR. With the enactment of the Prevention Act (Präventionsgesetz) in 2015, WHP became part of German social legislation. Health insurance providers are now required to promote health in the workplace, in addition to their previous duties under the statutory accident insurance and the Occupational Safety Act (Arbeitssicherheitsgesetz). This has led German companies to invest greater effort in voluntary forms of OH that appear, at least at first glance, to overlap with CSR. Such activities include offering fitness courses, mindful leadership seminars, or an ergonomic adjustment of workplaces in the interest of prevention. Recent research has reported that these individual-oriented interventions are already offered by three in ten German companies [11]. To assist the implementation of this new legislation, German health care insurers offer consultation services on how to design and implement OH measures for companies, various health promotion and prevention packages for direct implementation and financial support to companies [12]. Independent of the new Prevention Act, other direct financial incentives for companies are in place, for example, expenses on certain preventative health measures are income tax-free (up to 500 € per employee per year, § 3 Nr. 34 Income Tax Law/Einkommensteuergesetz). Since January 2019, companies are required to certify behaviour-based prevention services to maintain these tax benefits (§ 20 paras 2 & 5, Social Code Book/Sozialgesetzbuch V). Alongside these recent legislative changes, research suggests that in-house personnel from various departments (including human resources, strategy, sustainability, public relations, CSR etc.) are increasingly engaging in OHM activities (e.g., [13]) More and more, industry and trade associations are also developing guidance for companies on WHP and OHM, in addition to their more traditional role of enforcing existing health and safety regulations [14]. Other public institutions and organisations that specialise in occupational medicine, public health, occupational psychology etc., are also providing empirical data on health promotion in the workplace, and often develop freely available material, such as staff surveys based on empirical data or theoretical models for a wide range of OH interventions (e.g., the German ‘Initiative Health and Work’ (iga)). Moreover, it is common in large enterprises for employees to organise themselves in so-called health circles (not to be confused with the legally required in-house industrial safety committees). These circles tend to cover OHM topics such as smoking cessation and work-life-balance. They serve as an important intersection between management and employees, and can be established in a more or less bottom-up fashion [15]. By contrast, small and medium-sized enterprises rarely have their own in-house OHM systems, but can and do receive external support from public institutions or private providers [16].
Beyond regulatory compliance, several advantages to systematically linking OHM and CSR have been noted in the literature. It has been speculated that merging health promotion activities with CSR structures may potentially have several competitive advantages for companies [10, 17, 18]. In addition to benefiting from reputational gains and savings due to intra-organisational synergy, companies that merge their activities may be more successful in facing future challenges (such as demographic changes) [19]. Well-established OHM may also help companies to realise their key CSR goals, such as high employer attractiveness and in-house social commitment, as well as an enhanced corporate image and reputation among their consumers and business partners. In the long term, this has the potential to ultimately strengthen a company’s market position [20, 21]. In addition to improving employee health, OHM measures may also have social or ethical benefits, if they address organisational, communal or global justice issues [22, 23]. Addressing OHM and CSR jointly, therefore, may not only give companies a competitive edge [24], but could also facilitate the implementation of health promotion programmes as part of furthering social responsibility and promoting good business culture.
CSR and OHM, however, are usually overseen by different management branches and based on different sets of values [25]. Matten and Moon’s concept of implicit and explicit CSR is illuminating when considering the interplay between OHM and CSR [26]. Explicit CSR is conceptualised as deliberate and voluntary “corporate policies that assume and articulate responsibility for some societal interests”, while implicit CSR is regarded as “corporations’ roles within the wider formal and informal institutions for society’s interests and concerns”, reacting to their environment [26]. This approach takes into account the institutional impacts on a company. It also understands ‘institutions’ sociologically, i.e., not merely as organisations, but also as social norms, rules and values.
Following Matten and Moon, activities such as those based on Germany’s Prevention Act would thus fall under the concept of implicit CSR, while OHM activities that exceed legal requirements align with their concept of explicit CSR, if they are offered at the company’s own discretion (e.g., a regular free health check for every employee). The concept of implicit and explicit CSR is thus one of the established accounts of CSR that is well-suited to theoretically underpin the integration of OHM and CSR within a joint management framework. However, there is a lack of empirical research regarding the interfaces between OHM and CSR in companies and how the integration of the two management branches are perceived. Germany’s system offers a particularly useful model for examining the existing and potential interfaces between OHM and CSR due to the enactment of legislation requiring health to be promoted in the workplace. The aim of this study, therefore, is to examine key stakeholders’ views and experience regarding interfaces between OHM and CSR in German companies. A comprehensive overview of these issues will help identify the key facilitators and barriers to implementing a more systematic approach to synthesising OHM and CSR.