Promoting healthy lifestyles at work should complement workplace safety programs. This study systematically investigates current states of occupational health and safety (OHS) policy as well as practice in the European Union (EU). OHS policies of EU member states were categorized as either prevention or health promotion provisions using a manifest content analysis. Policy rankings were then created for each prevention and promotion. Rankings compared eight indicators from the European Survey of Enterprises on New and Emerging Risks-2 data on prevention and promotion practices for each member state using Chi-square and probit regression analyses. Overall, 73.1% of EU establishments take preventive measures against direct physical harm, and about 35.4% take measures to prevent psychosocial risks. Merely 29.5% have measures to promote health. Weak and inconsistent links between OHS policy and practice indicators were identified. National OHS policies evidently concentrate on prevention while compliance with health and safety practices is relatively low. Psychosocial risks are often addressed in national policy but not implemented by institutions. Current risk assessment methods are outdated and often lack psychosocial indicators. Health promotion at work is rare in policy and practice, and its interpretation remains preventive. Member states need to adopt policies that actively improve health and well-being at the workplace.

Depression is under-diagnosed and under-treated in most areas of the US. New York City is currently looking to close gaps in identifying and treating depression through the adoption of a screening and collaborative care model deployed throughout the city. We examine the cost-effectiveness of universal two-stage screening with the 2- and 9-item Patient Health Questionnaires (PHQ-2 and PHQ-9) in New York City followed by collaborative care for those who screen positive. We conducted microsimulations on hypothetical adult participants between ages 20 and 70. The incremental cost-effectiveness of the interventions over the average lifespan of a 20-year-old adult in NYC is approximately $1,726/QALY gained (95% plausible interval: cost-saving, $10,594/QALY gained). Two-stage screening coupled with collaborative care for depression in the clinical setting appears to be significantly less expensive than most clinical preventive interventions, such as HIV screening in high-risk patients. However, effectiveness is dependent on the city’s ability to manage scale up of collaborative care models.

Objectives: Airports in the U.S. have gradually been transitioning to automated flight systems. These systems generate new flight paths over populated areas. While they can improve flight efficiency, the increased noise associated with these novel flight patterns potentially pose serious health threats to the overflown communities. In this case study, we estimated the monetary benefits relative to health losses associated with one significant change in flight patterns at LaGuardia Airport, year-round use of “TNNIS Climb”, which happened in 2012 as a result of flight automation in New York City. Prior to that, the use of the TNNIS Climb was limited to the U.S. Open tennis matches. Methods: We developed a decision-analytic model using Markov health states to compare the costs and quality-adjusted life years (QALYs) gained associated with the limited use of TNNIS (old status quo) and the year-round use of TNNIS (current status quo). The TNNIS Climb increases airplane noise to above 60 decibels (dB) over some of the most densely populated areas of the city. We used this increased exposure to noise as the basis for estimating ground-level health using data from sound monitors. The total costs (including both direct and indirect costs), QALYs, and the incremental cost-effectiveness ratio (ICER) were estimated for the limited versus the year-round use of the TNNIS Climb. Results: The incremental lifetime costs and QALYs per person exposed to noise associated with the limited versus the year-round use of TNNIS was $11,288, and 1.13, respectively. Therefore, the limited use of TNNIS had an ICER of $10,006/QALY gained relative to the year-round of TNNIS. Our analyses were robust to changes in assumptions and data inputs. Conclusions: Despite increases in efficiency, flight automation systems without a careful assessment of noise might generate flight paths over densely populated areas and cause serious health conditions for the overflown communities.