Better Practice in Health by Design

Health by Design is a key area of work to improve the ways we manage health risk. It is part of the Railway Health and Wellbeing Roadmap and is therefore a key topic for the Health and Wellbeing Policy Group and the Musculoskeletal Disorders Working Group. These web pages represent the first phase of activity to develop industry capability that we need to make that improvement.


We believe we can create a significant reduction in risk to the rail industry and the people that work within it. This will need a community of professionals (clients, designers, users, project managers, product owners) to work together to improve how the industry designs out and manages health issues, and how we all manage health risks. This work represents the first phase of activity to build the community needed to drive change and the tools that can help companies do it.

Why act now?

There is currently no reference point for the rail industry for improving railway health by design. Other high hazard industries, such as construction, are starting to develop Health by Design principles. These give us an opportunity to learn from their approaches and to standardise Health by Design principles in the rail industry. At present developing capability in this area involves gathering learning from other design elements such as 'Universal design' and 'safe by design' activities. We need to bring them together, with case studies and examples, to develop our own Health by Design concepts.

The importance of good design is not in question. It is central to the latest developments in Buildings Information Modelling (BIM) and is found in law through the Construction (Design and Management) Regulations 2015. Good quality design is also an integral part of sustainable development. Safety by design has seen increased management attention over recent years because of the impacts it can have. Research commissioned by the Australian National Occupational Health & Safety Commission identified that:

  • of the 210 identified workplace fatalities in Australia, 77 (37%) definitely or probably had design related issues involved
  • in another 29 (14%) identified workplace fatalities, the circumstances suggested that design issues were involved
  • design is also believed to contribute to at least 30% of work-related serious non-fatal injuries

The need to develop this capability can be shown in some of the costs to the railway system from the cumulative effects of poor health and wellbeing management.

  • The associated cost of 'absenteeism' caused by impaired health to GB railway is in the region of £320m per year. If coupled with 'presenteeism' it could be as high as £790m per year.
  • HSE Health and Safety Statistics 2016/17 estimate the occupational ill health problem to be more than 4 times that of safety. Work-related ill health accounted for 82% (25.7 million days lost) compared with workplace injury (the realm of safety management) at 18% (5.5 million days).

From these figures we can see that the financial costs of poor employee health are high. We can also see that the health and safety effects of poor design for health are also likely to be significant. It is important that rail follows the lead of other industries and prestige projects to manage health by design.

Taking a measured approach

The image below details the Rail Industry Readiness table. Within the Health and Wellbeing Policy Group (HWPG) we loosely use this framework to guide our own and stakeholder expectations; and to recognise the necessary time and stages needed to develop a fully viable product. We trust, as we move through the stages, that the product becomes stronger and more viable. This project sits within our wider framework for Leading Health and Safety on Britain's Railway.

We regard the first phase of this project as taking the community and tools from the Concept level (RIRL1) to the Proof of Concept Level (RIRL3) on the Rail Industry Readiness table. We have identified a community and an initial set of tools and have made them available across these web pages. We now issue a call to action for others to engage with us, so that we can expand our community and work together to understand how best to evolve the material to suit your needs. 

Working to principles

The community choosing to come together should work with these five principles:

Principle 1: Persons with Control

Principle 2: Product Lifecycle

Principle 3: Systematic Risk Management

Principle 4: Healthy Design Knowledge and Capability

Principle 5: Information Transfer

Upholding values

Community members should uphold these values:

  • Maintain an ongoing conversation with and between clients and designers from a variety of backgrounds, to establish a focus on Health by Design and the benefits to be achieved
  • Continuous community improvement by gathering case studies, tools and good practices
  • Transfer of knowledge between industries
  • Work with projects, manufacturers and service providers to develop better Health by Design solutions
  • Use of a whole lifecycle view when creating design solutions
  • Ongoing work to support understanding of whole lifecycle costs and establish cost benefits of health interventions in design.
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