Putting Employee Health at the Forefront Pays Dividends in Injuries and Costs

Andrew Berry

American employers are reporting injuries at the lowest rate ever recorded. Injury statistics for 2021 will not be released until late 2022, but 2020 Bureau of Labor Statistics figures showed a decline in injury rate when compared to 2019. With workplace injury rates at an all-time low, employers may feel confident they’re currently doing enough to avoid injuries or that any improvements they could make would have marginal returns. In truth, a look into improving employee health could have additional sustainable and long-lasting results.

Stagnating injury rates

Private industry employers reported 2.7 million nonfatal workplace injuries and illnesses in 2020, compared to 2.8 million in 2019. The incidence rate of injuries, often used as the benchmark for employee injuries, fell to 2.2 cases per 100 FTE (full-time equivalent) workers from 2.6 cases in 2019.

Employee injuries and illnesses has fallen significantly over the past fifty years. Since the Occupational Safety and Health Act created OSHA (Occupational Health and Safety Administration) in 1970, injuries have fallen from a high of 11 cases per 100 FTE workers to the new low of 2.2 cases in 2020. Substantially lower injury rates can be attributed to multiple factors, including government oversight and regulations, less dangerous work conditions, automation, increased awareness of injury risks, employer safety programs, and reduction of US based manufacturing and industrial jobs.

Interestingly, over the last decade, the decline in injury rates has slowed. From 1999 to 2009, injury rates dropped from 6.3 cases per 100 FTE workers to 3.6 cases, but from 2009 to 2019, the rate of injuries fell by less than half of the previous decade’s rate, to 2.6 cases per 100 FTE workers.1 In 2018, injury rates did not decrease from the previous year for the first time since 1992, with cases holding steady at 2.8 per 100 FTE workers. Although the numbers show that total injury numbers continue to wane, Bureau of Labor Statistics shows that total rates may decline at a continued slower pace.

How will injury rates continue to fall?

Some of the drivers for stagnating injury rates can be attributed to the overall success of injury reduction. Many of the most apparent reforms and regulations have been put into place; the closer that injury rates get to zero, the harder it becomes to make improvements. Work injuries will never entirely disappear because of human error, environmental impacts, and unforeseen accidents that occur in the workplace. And despite the leaps and bounds made in the safety of equipment, it can still be misused or occasionally fail. In car manufacturer Volvo’s safety vision, for no one to be killed or seriously injured in a new Volvo, the company identifies three “gaps to zero,” that currently impede its mission – speeding, intoxication, and distraction.2 When a vehicle is safer than ever, the solution turns to the driver. The same principle can be applied to an employer’s workforce.

Employee health and work injuries

There is a well-established link between injury rates and the health, wellness, and lifestyles of employees. Employees who are overweight, have poor musculoskeletal and cardiorespiratory fitness, are diabetic, or smoke have higher rates of injury and longer durations to recover from injury.

Obesity is well-known for the list of comorbidities that can come with excess weight gain, including hypertension (high blood pressure), heart disease, arthritis, and sleep apnea. In the workplace, overweight and obese employees face a 1.4 times higher risk of a back injury and are more than 1.5 times more like to suffer a musculoskeletal injury.3

A 2014 study of Arizona firefighters comparing fitness level with injury risk found that firefighters with lower levels of fitness had an injury risk 2.2 times higher than those with high levels of fitness.4 Additionally, injuries in the firefighters with lower fitness levels were more likely to face prolonged recovery times, leading to higher case costs and extended time away from work.

The story is much the same for diabetic employees and employees who smoke. When compared to adults without diabetes, adults with diabetes have a higher risk of musculoskeletal pain and a higher average number of visits to the doctor because of their pain.5 Rotator cuff tears are more common among smokers, and they are 1.5 times more likely to suffer overuse injuries, such as bursitis or tendonitis, than nonsmokers.6

How employers can boost employee health

Cutting edge employers can find ways to boost employee health and further improve injury rates.


Diabetes can be managed and treated with medical intervention, but around 8 million American have diabetes with symptoms mild enough that they don’t know they have the condition. Employers can look to onsite medicals clinics and screening programs to bridge the gap. With an onsite clinic, employees have easy access to medical care, including exams that could identify diabetes.

If an employee is diagnosed with diabetes, innovative technologies such as continuous glucose monitor may be appropriate to provide real-time information to the employee for improved self-management and prevention of future disease sequelae.7 These devices collect blood sugar readings in five-to-fifteen-minute intervals and sound an alarm if a diabetic’s blood sugar drops to a dangerously low level or a high preset level. The data from a continuous glucose monitor also helps the clinician track, monitor, and work with the patient to effectively manage their diabetes.


Employers looking to fight obesity and low fitness levels may find success in bringing certified athletic trainers to their locations or perform vital sign and musculoskeletal screenings. Athletic trainers can assess and teach employees how to improve their overall and workplace health in a variety of ways, whether through exercise programs, classes on proper warm-up and stretching routines before work, or injury prevention programs.

Athletic trainers can also help ensure that employees can perform their essential job functions in a safe manner. After employees are offered employment, the employer can work with an athletic trainer to perform human performance evaluations (HPE).8 HPEs are designed to test a prospective employee’s ability to perform essential actions that will be a part of their new job responsibilities. During an HPE, the athletic trainer will screen vital signs and guide the prospective employee through a validated test of essential job functions.  If an employee is unable to complete the HPE the athletic trainer will communicate with the employer and provide feedback and recommendations for any potential accommodations based on the employee’s performance on the HPE.

Existing employees may benefit from worksite assessments in which an athletic trainer evaluates the work site for ergonomic hazards outlines recommendations to assist employees in reducing their risk of cumulative trauma disorders. Both HPEs and ergonomic assessments have the potential to improve employees’ musculoskeletal health and decrease risk of developing musculoskeletal disorders.

Employee retention and recruitment

Employees who focus on improving employee health may find benefits beyond fewer missed worked days and lower healthcare expenditures. Well-executed employee health programs become a benefit that can boost recruitment, employee retention, and save both the employee and employer time and money.

The connection between wellness programs and retention is well-established. A 2010 study by Principal Financial Group found that forty five percent of Americans would stay at their current jobs longer because of an employer-sponsored wellness program.9 The benefits are often two-fold, as employees feel encouraged to work harder and perform better while also taking fewer sick days. In 2022, PeopleKeep, a personalized benefits administration software company, reported that fifty one percent of employees who feel that their health is holistically considered were more likely to stay at their current organizations for at least 12 more months.10 Additionally, employees who feel that their health is valued are likely to recommend their current company as a good place to work. If anything, these study results show that employee wellness is increasingly tied to retention and recruitment.

Employers don’t have to shoulder the burden of creating and executing an onsite clinic or employee health program. An established occupational health provider can provide the infrastructure and support necessary. Investing in employee health now can pay dividends for years to come.


  1. Nearly 50 Years of Occupational Safety and Health Data,” by Jeff Brown. U.S. Bureau of Labor Statistics. July 2020.
  2. Volvo Cars' Safety Vision,” Volvo, 2022.
  3. Finkelstein EA, DiBonaventura MD. Burgess SM, Hale BC. The Costs of Obesity in the Workplace. Journal of Occupational and Environmental Medicine. October 2010; 52(10):971-976.
  4. Poplin GS, Roe DJ, Peate W, Harris RB, Burgess JL. The association of aerobic fitness with injuries in the fire service. 2014;179(2):149-55.
  5. Type 2 Diabetes is Associated with a Higher Risk for Musculoskeletal Pain,” Endocrineweb. May 22, 2018.
  6. Smoking and Musculoskeletal Health,” American Academy of Orthopedic Surgeons. May 2010.
  7. Krichbaum M, Loerbroks A, Nguyen QX, Scharf J, Vu-Eickmann P. Perceived Usefulness of Continuous Glucose Monitoring Devices at the Workplace: Secondary Analysis of Data From a Qualitative Study. Journal of Diabetes Science and Technology 2019; 13(2): 242–247.
  8. Pre-employment Physical for Work,” Concentra, n.d.
  9. Wellness Programs as an Employee Retention Tool,” by Stephen Miller. SHRM. January 20, 2010.
  10. How to Improve Employee Retention with a Workplace Wellness Program,” by Chase Charaba. PeopleKeep. April 19, 2022.