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Giulia Maistrello, Senior Analyst at RAND Europe
Giulia Maistrello is a Senior Analyst at RAND Europe, specialising in workplace health, safety, and wellbeing. Her work covers a range of topics, including occupational safety and health, employee wellbeing, healthcare improvement, and the evaluation of health services.
While great improvements have been made in recent decades towards reducing work-related accidents and injuries globally, disparities in safety outcomes within and between countries remain concerning.
Fatalities from occupational injuries are disproportionately higher in low- and middle-income countries (LMICs). Furthermore, data from these regions are often sparse and inconsistent in quality, so the true scale of the issue may be underrepresented.
Reliable evidence about what works to prevent injuries and illness in the workplace is central to addressing these challenges and improving safety. However, previous RAND Europe research (also funded by Lloyd’s Register Foundation) found a mixed picture in how evidence relating to occupational safety and health (OSH) is generated and applied.
Supported by the Foundation, RAND Europe has been conducting a research programme to further investigate the quality of the OSH evidence ecosystem and what evidence OSH practitioners need.
The two new reports RAND Europe have produced provide complementary insights into the challenges and opportunities within the OSH evidence landscape. Together, they highlight the tension between the evidence that OSH practitioners need to support decision-making, and the current state of the evidence base available to them.
The first report focused on the needs and experiences of OSH practitioners, particularly in high-risk sectors. Based on interviews with practitioners worldwide, the study noted some deficiencies in the OSH knowledge base, and emphasised that accessible, relevant and tailored evidence is important to better support their decision-making.
Practitioners from LMICs especially reported the need for context-specific evidence. They raised concerns about adapting health and safety tools developed in high-income countries (HICs) and emphasised that relying on academic literature from Europe or North America often fails to account for cultural and contextual differences, making these tools less effective in LMIC settings.
Practitioners from both LMIC and HIC contexts reported challenges in accessing actionable evidence. Common issues included limited availability of data, inadequate data quality, and inconsistent mechanisms for recording and passing knowledge within organisations. These issues are especially felt in emerging industries such as renewable energy, where insufficient data make it difficult to identify emerging risks and develop interventions.
Finally, while practitioners affirmed that safety culture is seen as important in high-risk sectors, the lack of practical evidence makes it difficult to implement solutions effectively. Many also emphasised that better training and methodological expertise are needed to properly collect and analyse data and transform evidence into practical applications.
The second report is a systematic review of reviews of OSH interventions. It aimed to map the existing evidence base for the effectiveness of these interventions and evaluate the quality of the underlying research.
The review raised significant concerns about the fragmented and inconsistent quality of the OSH evidence base, reinforcing findings from the first report. It identified substantial methodological flaws in primary studies, including the absence of objective measures of safety outcomes, inconsistent definitions of key concepts, and inadequate testing of theories of change or causal pathways between interventions and outcomes. However, a minority of primary studies did incorporate objective measures, clear definitions, and testing of theories of change, making them considerably stronger.
The report also found that literature reviews in this field are of varying quality, reducing their utility for practitioners seeking reliable and actionable insights from evidence synthesis. Some reviews are more robust, featuring clear inclusion and exclusion criteria, efforts to control biases, and evidence quality assessments. However, there remains no consensus on the most appropriate methods for evaluating primary studies in this field, highlighting the need for quality appraisal tools designed specifically for OSH research.
These two reports together emphasise the need for a stronger OSH evidence ecosystem, built on robust research methods and complemented by accessible, relevant resources for practitioners.
The current OSH evidence base is highly fragmented, reflecting the sector-specific and context-dependent nature of workplace safety. The diversity of risks, regional infrastructure, regulatory environments, and cultural norms across industries and geographies complicates the creation of universal best-practice frameworks. But while OSH practitioners benefit from localised and context-specific insights to tackle unique challenges, they also need reliable and generalisable evidence to guide their decisions. The lack of methodological consistency across studies makes this fragmentation worse, rendering much of the available evidence of unclear quality or difficult to apply effectively.
To address these challenges, the adoption of more rigorous and standardised methods for collecting, synthesising, and evaluating evidence is crucial. The second report highlights the potential of borrowing best practices from other fields, such as healthcare, where systematic evidence synthesis and standardised critical appraisal tools have strengthened the credibility and practical value of research findings. Developing tailored appraisal tools specifically for OSH could further enhance the ability of practitioners to critically assess evidence and apply it effectively in decision-making.
Additionally, clearer and universally accepted definitions are needed for key OSH concepts. For example, ‘safety culture’, which is considered very important by OSH practitioners, often suffers from inconsistent definitions and limited evidence supporting its practical implementation. Developing consensus-based definitions and frameworks for concepts like this would help to unify research efforts and make findings more actionable.
These reports highlight the potential to make a real difference in how evidence is generated and used in OSH. Strengthening research methodologies, developing adaptable formats for diverse user needs, and ensuring practitioner-focused approaches can transform OSH research into actionable insights that protect lives and improve working conditions worldwide.
The two reports collectively provide a roadmap toward an OSH evidence ecosystem where evidence availability and practitioner needs align. Achieving this vision requires a combination of rigour, accessibility, and collaboration. While substantial challenges remain, the path forward is promising, offering a real chance to drive meaningful change in workplace safety practices globally.
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