The Social and Health Impact of Accidents at Work: The Analysis of the Italian Case

Abstract

The months of a gradual exit from the pandemic show some significant data and phenomena regarding the phenomenon of accidents at work and occupational diseases. The Italian figure highlights a recovery in injuries and illnesses, but also in the impact of new risk factors deriving from the digitalization of work, which grew with smart working during the pandemic. At the same time, the new organizational models highlight the increased risk of work-related stress diseases. The Italian situation makes clear the need to intervene on the issue of organizational well-being and welfare, to limit the negative impact of risk factors associated with this economic system on society and the health system through a new work culture.

1. Introduction

Italy is the second country in Europe for manufacturing production and the nation week in the world from the point of view of industrialization, albeit with a limited territory and population. For many decades, this process of industrialization has had to face various problems relating to situations of risk of accidents at work. Each economic phase involves the definition of different risk conditions. The passage from the industrial model to a tertiary economy and to the “Fourth capitalism” has led many countries to the overcoming of the central function of manufacturing production, for the promotion of a system based on services. This has also happened to countries with a great industrial tradition, such as Italy and Germany. However, this situation has not entirely limited the conditions of exposure to the risk of accidents at work: the maintenance of a significant presence in industrial production has been accompanied by the new risk conditions that characterize the new economic models and which extend to the sector of tertiary and services. For this reason, in the last 20 years, Italian legislation and the system of employment contracts have placed a strong focus on the prevention of risks at work, introducing important obligations for each company and specific figures, such as the Safety Manager. Italy has a very significant law regarding the prevention and protection of health and safety in the workplace, the “Consolidated text for health and safety in the workplace” [1] (Legislative Decree no. 81 of 2008), a national body called Inail which carries out insurance activities, but also for the prevention of occupational risks, information, training, and assistance in the field of safety and health at work and a national inspection agency for checks in companies. However, the issue of exposure to the risk of accidents at work remains a very present phenomenon, which must be considered due to the following in-depth elements, which constitute important aspects of the evolution of the economic and production system, destined to produce effects also in the coming years:

• The presence of conditions of exposure to the risk of accidents in small industrial enterprises, in subcontracting and in less structured production contexts;

• The evolution of risk characteristics due to technological innovation and digitalization and in the tertiary and service sectors;

• The presence, in addition to the risk of accidents and injuries, of increasing exposure to pathologies connected to the phenomenon of “work-related stress”.

This situation must be seen as a whole and determines significant impacts on society and on the health of citizens, which is useful to examine and evaluate.

2. The methodology used for the analysis of the reference data

The primary source of the analysis contained in this essay is the Information System of accidents reported to Inail, the Italian public institution that has insurance and preventive functions to combat the phenomenon of accidents at work. This database is extremely detailed and updated every 3 months and in particular evaluates the trends in the different types of accidents and for the different territories. However, the hypothetical assessment of unreported accidents, especially present in some economic areas and territories, was also taken into consideration. The focus on work-related stress takes into account the compensation claims submitted by workers to Inail, but also in this case the trend phenomenon is taken into account, as many situations may not have been reported. The methodology, therefore, considers the empirical and factual datum, but completes this datum through a phenomenological evaluation of the current trends, in the face of the possibility of having a complaint that does not correspond to all situations of injury or risk. In particular, with respect to the impact of digitization and the role of smart work, a survey carried out by the Foundation for Labor Consultants was considered on a statistically significant sample.

This essay, therefore, proposes, as an innovation of the methodology for the analysis of the evolution of the risk of accidents at work and the worsening of safety conditions, the evaluation, and consideration of factual data deriving from official reports of accidents, including reports of work-related stress, to the public institution Inail, in connection with the phenomenological analysis of trends, supported by correct surveys on an evaluation level. In this way, a more complete assessment of the reality and extent of the phenomena and the evolution of risk factors can be connected to the analysis of what has actually been reported.

Among the various initiatives of Istat, the Italian national research body for statistics, aimed at gathering the information necessary for the analysis of the effects of the health crisis on the economy and society, in May and November 2020, two specific surveys aimed at understanding how Italian companies have experienced such a dramatic phase, with particular reference to the economic, financial and employment impact. These researches constitute an important component in defining the proposed methodological framework.

3. The current situation and 2020 data

The phenomenon of accidents at work in Italy is read through the data of the complaints to Inail and shows how the first months of economic recovery in 2021 led to an increase in risk situations and accidents. Among other things, it must be taken into account how reporting to Inail represents a legal and correct method of verifying the accident phenomenon, but how in Italy there is the problem of accidents not reported to the national insurance institution, especially in situations concerning the conditions of irregular work, present above all in some sectors. In any case, the latest Inail report of 2021 [2] shows an increase in the accident phenomenon of particular significance. In the period January–August of this year, compared to the same period of 2020, there was an increase in overall accident reports, a decrease in fatal ones, and a rise in occupational diseases. The reports of accidents at work submitted to Inail by last August [3] were 349,449, over 27,000 more (+ 8.5%) compared to 322,132 in the first 8 months of 2020, a summary of a decrease in complaints observed in the quarter. January–March (−11%) and an increase in the April–August period (+ 26%) in the comparison between the 2 years. The data collected on 31 August of each year show in the first 8 months of 2021 a national increase in accidents while commuting, that is, those occurring on the return journey between the home and the workplace (+ 20.6%, from 38,001 to 45,821 cases), which decreased by 32% in the first 2 months of this year and increased by 59% in the period March–August (thanks to the massive use of smart working last year, starting from March), and an increase of 6.9% (from 284,131 to 303,628) in those occurred on the occasion of work, which fell by 10% in the first quarter of this year and increased by 22% in the April–August period. The number of reported work accidents increased by 6.9% in the Industry and Services insurance management, by 3.6% in Agriculture, and by 29.2% in the state sector. The territorial analysis shows a decrease in complaints only in the North-West (−3.6%), as opposed to the Islands (+ 16.5%), the South (+ 14.9%), the Center (+14, 5%), and the North-East (+ 13.6%).

The increase that emerges from the comparison of the first 8 months of 2020 and 2021 [4] is linked only to the male component, which records a + 14.7% (from 195,612 to 224,400 complaints), while the female one is down by 1.2% (from 126,520 to 125,049). The increase affected both Italian workers (+ 7.8%) and non-EU (+ 14.5%) and EU workers (+ 2.5%). The analysis by age group shows a decline only among the 15–19 year olds (−0.7%), with increases for the 20–49 year-old group (+ 9.9%) and among the over 50s (+3, 5%).

The reports of accidents at work with a fatal outcome submitted to the Institute by August were 772, 51 less than the 823 recorded in the first 8 months of 2020 (−6.2%). The comparison between 2020 and 2021 requires caution as the data of the fatal reports of the monthly open data, more than those of the reports as a whole, are provisional and strongly influenced by the covid-19 pandemic, with the result of not counting a significant number of “late” fatal reports of contagion, in particular relating to the month of March 2020. At the national level, the data collected on 31 August of each year show an increase only in cases occurring in progress for the first 8 months of this year, went from 138 to 152 (+ 10.1%), while those at work were 65 less (from 685 to 620, −9.5%). The decrease observed in the comparison between the first 8 months of 2020 and 2021 is linked both to the female component, whose fatal cases reported went from 83 to 78 (−6.0%) and to the male component, which went from 740 to 694 cases (−6.2%). The decrease concerns the complaints of Italian workers (from 700 to 663) and EU workers (from 41 to 25), while those of non-EU workers went from 82 to 84.

As of August 31, 2021, 12 multiple accidents occurred in the first 8 months for a total of 29 deaths, 17 of which were road accidents. Last year, however, there were six multiple accidents recorded between January and August, with 12 fatal cases reported, half of which were road accidents. The complaints of occupational disease registered by Inail in the first 8 months of 2021 were 36,496, 8735 more than in the same period of 2020 (+ 31.5%), a summary of a decrease of 26% in the January–February period and of an increase of 66% in that of March–August, in the comparison between the 2 years.

The pathologies reported, therefore, start to increase again, after 2020 strongly conditioned by the pandemic with reports in a constant decrease in comparison with previous years [5, 6, 7]. In fact, last year, arrests and restarts of production activities reduced exposure to the risk of contracting occupational diseases. Pathologies of the osteo-muscular system and connective tissue, of the nervous system, and of the ear continue to represent, even in the first months of 2021, the first three occupational diseases reported, followed by tumors, which exceed those of the respiratory system in August.

This situation, which exposes the data of the national information system of Inail, provides for interventions on the system of rules, which the Italian government has announced and which also concern the strengthening of inspection and control activities. However, it seems important to point out the impact that the accident phenomenon continues to have on the social and health system and how the evolution of the economic system has introduced some risk factors that can be addressed not only through increased controls but also through different ways of carrying out the work performance, greater attention to organizational well-being and a widespread introduction of corporate welfare tools. The accident data does not derive only from the introduction of dangerous work tools and the lack of controls in some sectors, but is often a consequence of excessive workloads, the acceleration of work times, and a “culture of performance” and productivity which increases risk margins and which, when it does not cause an injury, in any case, causes an increase in the condition of “work-related stress” [8, 9, 10].

4. The phenomenon of accidents for working women

In this context, it becomes useful to analyze the impact of the phenomenon of accidents on the female component of Italian work. Also in this case it becomes useful to analyze the trends shown by the Inail database on the evolution of accident reports reported is more present. This makes this assessment partly underestimated. However, the data show us that in some situations it is women who appear to be more exposed to greater conditions of risk. If we analyze the most consolidated annual Inail data in the period between 2015 and 2019, accident reports [11, 12, 13] presented to Inail increased overall by 1.3% (from 636,674 in 2015 to 644,970 in 2019).

Faced with an increase in female employment equal to +1.1% 1, the complaints and accidents of female workers went from 227,068 in 2015 to 231,128 in 2019, equal to a percentage increase of 1.8%, higher than that recorded among male workers (+ 1.0%), for which Istat recorded an increase in employment equal to +0.3%. In the same 5 year period, the incidence of women in total accidents was almost constant and on average equal to 35.8%. On the other hand, reports of accidents with fatal outcomes among female workers decreased, from 117 cases in 2015 to 97 in 2019, equal to −17.1%, more markedly than the 8.9% reduction recorded over the same period of time among workers. It is important to point out that the incidence of accidents for female workers is particularly high in the domestic and family services sector (domestic workers and carers), with 89.9% of the total complaints in the sector, followed by health and social assistance (74, 2%) and from the packaging of clothing items (70.9%), while in the riskiest sectors of the industry it drops to 2.8% recorded in construction. The complaints related to the insurance policy against domestic accidents (mandatory for all people aged between 18 and 67 who take care of the home in a habitual, exclusive, and freeway), in 2019 were a total of 760 and registered an exceptional increase of 58.3% compared to 2018, when 480 were registered. Almost all (742) concerned women and no cases with a fatal outcome were recorded in 2019, compared to 20 cases in 2015–2018. A truly significant figure is that which concerns the overall complaints of accidents at work “in progress”, that is, occurring on the return journey between home and work, which continue to be for female workers, even in 2019, more than men: 54,299 cases against 51,524. In relative terms, ongoing cases represent 23.5% (practically one in four) of female complaints (231.128) and 12.5% (just over one in ten) of male ones (413.779). For complaints with a fatal outcome, the incidence of this type of accident among female workers is even higher: in 2019, almost one in two female deaths (44 out of 97, 45.4%) occurred in progress, a ratio that for men dropped to about one in four (281 out of 1087, 25.9%). A gender difference that is confirmed by looking at the broader category of accidents “outside the company” (sum of all accidents while traveling and those during work occurring with the means of transport involved) generally attributable to the risk of road traffic: 25.3% (58,396) of female complaints against 16.1% (66,485) of male ones.

5. Data analysis

For a correct analysis of the phenomenon of accidents, it is necessary to consider how, in addition to issues of a cultural nature, one of the major problems concerning the scourge of deaths and accidents at work—in Italy and beyond—is that relating to the measurement of the phenomenon as when comparing the data between countries, the incidence rates are difficult to interpret. In fact, the probability of going into an injury is, among other factors, related to the work activity that the worker carries out and the weight of the different economic activities varies from one country to another depending on the structure of each economy. Furthermore, a higher number of accidents ascertained at work does not necessarily indicate worse safety conditions; on the contrary, it may indicate a greater propensity to report and therefore paradoxically better protection of the worker. It should also be considered that among the various injured, sick, and dead at work, there is a part of workers in irregular conditions that are difficult to estimate. It should also be considered how in Europe those accidents on the way from home to work or vice versa are not considered in the data, i.e., accidents “in itinere”, which the Italian system instead evaluates and considers from an insurance point of view. In any case, if we consider the pre-Covid data, Italy ranks above the EU28 average (1.8) for the number of deaths at work out of the total number of employees, with 2.3 deaths per 100,000 employed. Among the states most similar to Italy, France recorded a higher figure (2.7); the United Kingdom (0.8), Germany (0.8), and Spain (2) a lower figure. The phenomenon of unreported accidents should also be considered: the “Independent Observatory of Bologna on the fallen from work” believes that a high number of deaths at work escapes the statistics on the phenomenon [14]. This observatory includes in its data irregular workers, unreported deaths, and a portion of fatal injuries not ascertained by Inail. According to the independent Bolognese Observatory, 2019 would even have ended with 1437 workers who died at work: 701 in the workplace, 736 in transit; a figure double that of Inail.

In any case, the accident phenomenon represents a very present reality for Italy and with the increase in accidents coinciding with the resumption of post-Covid economic activities, it appears important to initiate careful preventive action, which also concerns the culture of health at work itself. In this effort, it is also important to point out how risk factors are often linked to the rhythms imposed on the job and not only to a lack of attention to prevention. The data on the evolution of work-related stress and related pathologies constitutes an interesting aspect in this sense (Figures 1–3).

Figure 1.

Variation in accidents.

Figure 2.

Variation in fatal cases.

Figure 3.

Variation in occupational diseases.

6. The advanced tertiary sector and related work stress

If construction and manufacturing activities are still the most significant components of the accident phenomenon, the issue of occupational diseases, with their relative impact on the health system, increasingly concerns the tertiary sector as well. In this context, the phenomenon of work-related stress has grown in recent years, linked to increasingly widespread pathologies. Work-related stress occurs among workers when the demands made on them exceed the ability to cope with it, with harmful consequences for health and mental balance, which are also reflected in the relational life of those affected. Some examples of working conditions that involve psychosocial risks and which could therefore cause work-related stress are:

• Excessive workloads;

• Conflicting requests or lack of clarity on roles;

• Lack of involvement in decision-making processes affecting workers;

• Inadequate management of organizational changes, job insecurity;

• Ineffective communication, lack of support from colleagues or superiors;

• Physical and psychological violence against the worker, perpetrated by the employer or by third parties.

• From these situations, characterized by a strong dysfunctional protracted over time, symptoms may arise that can cause real occupational diseases:

• Psycho-emotional such as anxiety, fear, obsession, hypochondria, hysteria, paranoia, depression, aggression, low self-esteem, and sleep disturbances, which amplify the risk factors for neuropsychiatric diseases;

• Physical, affecting organs and systems such as the cardiovascular system (with consequent arterial hypertension), the gastrointestinal system (with gastritis, gastric ulcer, and ulcerative colitis), the osteoarticular system (with pain in the spine, scapulohumeral periarthritis, and muscle tension), or immune or psychosomatic pathologies (such as dermatitis, psoriasis, hyperhidrosis, skin rashes);

• Behavioral, which amplify the risks of accidents, alcoholism, smoking, drug addiction and also compromise the relational and family balance of the worker.

Intense and prolonged stress over time can cause psychosomatic, physical, mental, and behavioral disorders, even severe ones, in workers, with more or less stable effects. By analyzing the relationship between work-related stress and some pathologies, in fact, a directly proportional correlation was identified between the risk of psychological deficit and an increase in work stress. The conditions most often encountered range from mood disorders, to alterations in the sleep-wake rhythm, to interpersonal and family conflicts, up to burnout and depression. A pre-existing psychophysical disorder, such as that of adaptation or post-traumatic stress disorder, can also coexist with one related to work events, sometimes strengthening it. Alongside these psychosomatic and behavioral disorders, the consequences of prolonged work-related stress can also affect the cardiovascular and nervous, endocrine, gastrointestinal, and immune systems. There is also a link between work-related stress and musculoskeletal disorders [15].

In Italy, in the case of pathologies due to work-related stress, in order for Inail to deliver the relative economic services, the worker must demonstrate that the pathology is caused by an adverse working condition, reconstructing (through documentary and possibly testimonial evidence) work environment that contributed to the emergence of occupational stress disease.

Mental disorders can be considered of professional origin, and therefore eligible for compensation by Inail as an occupational disease, only if they are caused, even if only predominantly, by situations of organizational coercion, that is, if they involve clear and relevant consequences on the working position and on the possibilities of carrying out the work. Stress itself is not a disease, but its consequences may be. Continuous exposure to situations and sources of stress can in fact lead to physical and psychological somatization of the problem. In recent years, the evolution of pathologies and the data of occupational diseases in Italy reported by Inail makes evident the presence and growth of the phenomenon of work-related stress.

According to the European Agreement on work-related stress of 2004, stress is “a condition that can be accompanied by disorders or dysfunctions of a physical, psychological or social nature and is a consequence of the fact that some individuals do not feel able to meet the demands or to the expectations placed in them” [16]. Work-related stress can therefore potentially affect every workplace and every worker as it is caused by different aspects closely related to the organization and the work environment.

In Italy, the current regulatory framework, consisting of Legislative Decree 81/2008 and related laws, obliges employers to assess and manage the work-related stress risk on a par with all other risks, in acknowledgment of the contents of the European agreement. In this regard, the Permanent Advisory Commission for Occupational Health and Safety has developed the necessary information for assessing the risk of work-related stress, identifying a methodological path that represents the minimum level of implementation of the obligation. The Department of Medicine, Epidemiology, Occupational Hygiene, and the Environment has developed a Methodology for assessing and managing work-related stress risk and published a specific online platform that can be used by Italian companies to carry out risk assessment pursuant to Legislative Decree 81/2008.

The proposed method offers companies validated tools and specific resources, which can be used by companies following a sustainable and integrated approach, divided into phases, which involve the involvement of prevention figures and workers. The aspect of the risk from work-related stress, also in the assessment of the allowances recognized by Inail, which represent only the most evident and emerged aspect of a much broader phenomenon, show how the evolution of work and its organization, despite the perspective of Fourth Capitalism, it continues to produce conditions of risk to health and safety, whether physical, mental or psychological. In this dimension, the aspects connected to the digitization and its impact on working conditions must also be considered, which the spread of smart working during the months of the pandemic has made it particularly widespread everywhere, even in Italy.

7. The covid risk and the impact of the digitalization of work

The pandemic had a significant impact on every dimension of the world of work, but the one that was most disrupted was health and safety. The explosion of an event with disruptive potential in terms of risks to the health of workers and the entire population has led, in the space of a few days, to drastic choices with the closure of many activities and to stringent measures that have seen a vast adjustment by part of the companies. These have been committed, both from an organizational and economic point of view, not only to guarantee the minimum prevention measures (from sanitization to the distribution of masks, as many as 98% of Italian companies have done so) [17], but also to provide adequate information to employees (94.7%), provide specific training (90.4%), rotate staff or program staggered access and exits (70%), make various types of tests available to collaborators (52%) and exempt the most fragile workers or with specific assistance problems from the obligation to be present (46.2%). Measures that have transversally affected the business world, from large to small which, despite a 1000 difficulties, have nevertheless adapted their organizational and management models to the standards imposed by the pandemic: standards in many cases onerous, both from an organizational point of view than cheap. The efforts were rewarded by the results, with containment of accidents from Covid in the workplace and causes of mortality: as of March 31, 2021, Inail accounted for 165,000 accident reports from Covid, mostly concentrated in the health sector (67.5%), of which 551 with fatal outcome. This is a high figure, considering the overall impact of Covid accidents on the total of those reported (infections caused by the Sars-Cov-2 virus in 2020 accounted for 23.6% of reports and 33.3% of those fatal), but relatively contained when compared to the effects, in terms of infections and mortality, produced by the epidemic.

At the same time, the widespread use of agile work as the main tool for preventing the spread of infections in the workplace, in addition to containing the risk, has had the positive effect of producing a significant drop in accidents while traveling. This dynamic marks an important discontinuity with respect to the trends of recent years which, in the face of stability of accidents in the workplace, had seen the number of those in transit progressively increase, especially among women.

The development of smart working as a new organizational model, if on the one hand has positive effects with reference to accidents and mortality at work, on the other, poses new challenges in terms of health and safety. A growing responsibility of the worker is necessary and required, who are asked to collaborate to better organize their domestic work station, in order to ensure adequate safety and prevent the occurrence of accidents or the onset of diseases. In this context, the risk margins potentially linked to the safety of a work environment that can vary over time widen (27% of agile workers worked from a place other than their home, even for prolonged periods), which is not said it complies with the minimum plant safety regulations (electrical, fire prevention) or that it has adequate and equipped workplaces and environments according to ergonomic criteria.

To these aspects is added the risk of increased stress produced by the expansion of working times, by performance anxiety, by the weakening of company relations, and by the fear of marginalization, already identified by various surveys by almost half of the agile workers such as elements of the discomfort of working remotely. These are the first elements of an experience that is still being evaluated, but whose impact on the health and safety dimension could be disruptive, both in terms of limiting the accident phenomenon and innovating the prevention and safety logic, which must be made more functional to the new organizational models. The emergency, in addition to making “the risk” tangible and real, has brought this dimension to the center of the strategies and of the company organization, paving the way for an unexpected coincidence of interests between the parties: health protection on the one hand, and safeguarding business activity on the other. An important step which, induced by the emergency of the moment and the need to adopt all the necessary measures to contain risks and infections, also resulted in the launch of a more participatory model of health and safety management in the company, which has become a shared value between all the parties, who have undertaken to implement, in a logic of prevalent collaboration, the most suitable measures to protect the health of workers on the one hand and the business activity on the other. The extraordinary survey carried out by Istat in December 2020 [17] on Italian companies with more than three employees, clearly highlights from this point of view the significant effort made by Italian companies to adapt to health protocols and the new rules and obligations imposed by the pandemic. It should be considered that 58.7% of the companies had to make changes to the work environments to ensure spacing, through the use of barriers, signs to trace different paths: a measure that is strongly conditioned by the size of the structures, affecting especially the large ones with more than 250 employees, where “structural” interventions were made by 85.9% and to a lesser extent, but still important, the small ones, as even among companies with less than 10 employees, are 57% are involved in these types of initiatives. In the face of the measures relating to the work environment, the companies had to make important organizational interventions to ensure safety within the premises, in compliance with the health protocols provided. The experience of the last year has led to new leadership of companies and employees in the management of safety at work, which could mark an important step towards a more participatory and shared intervention logic.

The challenge of the Fourth Capitalism, the ongoing digitization, and the characteristics of the new organizational models of work entail in any case new risk factors for the health of citizens, which must be faced with tools, rules, and with a different culture of prevention, of work, and corporate well-being.

8. International health security and coordination of action to combat the accident phenomenon

What is dealt with in Italy by the institutions responsible for preventing and combating the phenomenon of accidents at work finds an international reference at the institutional level, first of all in the role of the International Labor Organisation (ILO), the World Labor Organization.

Worldwide, it is estimated that every 15 sec a worker dies on the job due to an accident at work or an occupational disease. Every 15 sec, 153 workers have an accident at work. It is also estimated that 6300 people die every day from work-related accidents or occupational diseases, causing more than 2.3 million deaths a year. The injuries which are prolonged work on-site annually 317 million, many of which involve sick leave from work. The human cost of these tragedies is enormous and the economic burden of inadequate occupational safety practices is estimated to be 4% of the world’s gross domestic product each year.

The work that the ILO carries out in the field of health and safety at work intends to develop and increase awareness, worldwide, of the consequences of accidents, injuries, and occupational diseases in the workplace, through information and assistance activities for all male and female workers internationally, and supporting practical action at all levels. The ILO has adopted more than 40 conventions and recommendations relating specifically to occupational health and safety and has adopted over 40 codes of conduct. The recommendations and indications of the ILO constitute an important reference for the action of governments and in particular the Italian government, in its law enforcement policies, has carefully followed the various ILO indications, in particular in recent months on aspects relating to the return to the work safely during the Covid-19 pandemic. In particular, the ILO document of May 2020 [18], which defines the actions necessary for returning to work in safe conditions, should be mentioned. This tool provides guidance to employers, workers, and their representatives on preventive measures for a safe return to work in the context of Covid-19. The tool follows the ILO’s established principles and methods on risk management for occupational safety and health and requires the involvement of workers. The tool must be adapted to national guidelines and does not address higher risk sectors, such as health services, and has been considered in the provisions adopted by the Italian government in recent months.

The European reference institution is the European Agency for Safety and Health at Work Occupational Safaty and Health Administration (EU-OSHA). This institution works to make EU workplaces safer, healthier, and more productive, for the benefit of companies, workers, and governments, and to foster a culture of risk prevention aimed at improving working conditions in Europe. In particular, these EU-OSHA benchmark actions need to be considered:

• Healthy and Safe Workplace campaigns: these biennial campaigns raise awareness of occupational health and safety (OSH) issues in Europe;

• The online interactive risk assessment (OiRA) project, which provides online tools for small and medium-sized enterprises to assess and manage risks in the workplace;

• The European Survey Of Entreprises On New And Emerging Risks (ESENER) survey: this comprehensive survey offers an instant description of how to manage health and safety risks in European workplaces;

• Forecasting projects: which highlight new and emerging OSH risks with specific forecasting projects.

The institutions that operate in Italy for prevention and safety at work act using the instrumentation and analysis carried out by the European OSHA Agency. In recent months, EU-OSHA is implementing a series of forecasting projects aimed at assessing the possible effects of new technologies and new ways of working as well as social changes on the health and safety of workers. Projects aim not only to identify new risks as they emerge but also to anticipate changes that could affect health and safety in the workplace. EU-OSHA foresight projects use a variety of methods, including literature reviews, expert consultations, and scenario development.

The purpose of this work program is to inform policymakers and to help define priorities for action and research. Foresight studies can have a major impact on decisions to be made, for example by helping policymakers find innovative solutions and promoting a long-term strategic approach.

The reference European policies and the indications of the European Commission must then be considered, which constitute the priority area of international health security for Italy. In this sense, the provisions of the EU Strategic Framework on health and safety in the workplace 2021–2027 must be considered: “Safety and health at work in a changing world of work” [19]. EU legislation on health and safety at work (OSH) is essential to protect the health and safety of the nearly 170 million workers in the EU. Protecting people from risks to health and safety in the workplace is in fact a key element in guaranteeing decent and lasting working conditions for all workers. This has made it possible to reduce occupational health risks and improve OSH standards within the EU and across all sectors. However, challenges remain, and the covid-19 pandemic has exacerbated the risks that need to be addressed. The protection of the health and safety of workers, enshrined in the Treaties and the Charter of Fundamental Rights, is one of the basic elements of an EU economy serving citizens. The right to a safe and healthy workplace is reflected in Principle 10 of the European Pillar of Social Rights and is fundamental to achieving the United Nations Sustainable Development Goals, as well as being a constituent element of the European Union of health in progress of development.

The new OSHA 2021–2027 framework, announced in the European Pillar of Social Rights Action Plan, sets out the priorities and key actions needed to improve the health and safety of workers over the next few years in the post-world context pandemic, characterized by green and digital transitions, economic and demographic challenges, and the evolution of the concept of the traditional work environment.

9. Conclusions

Undoubtedly, smart working has had a very positive effect in terms of contraction of the accident phenomenon, allowing an important reduction of accidents during the journey that have always presented greater criticalities both in terms of management and prevention, also because they are not immediately related to the working environment. However, the evolution towards an agile work model, made up of growing hybridization between face-to-face and remote activities, also poses new challenges in terms of managing the health and safety of workers. Beyond the indications of the law, and the employers’ provisions, it is evident that some typical elements of smart working, of remote work, as it has taken shape in the experience of the last year, raise many questions about the actual capacity for the protection of the health and safety of workers, where, beyond the training and training obligations of the employer, a large part of the responsibility is entrusted to the worker: think of the necessary electrical and fire safety to be guaranteed inside the elected home workplace, at the workstation, which must be defined and equipped according to ergonomic criteria or the possibility of carrying out work remotely from places and contexts other than the usual, for which it is difficult to imagine that conditions and safety procedures.

Mobility from one workplace to another, outside the company, represents a potential factor in increasing health risks. The alternation of places increases the risk of the inadequacy of domestic workstations, which already appears to be a “critical” factor for the health of workers. A survey carried out by the Labor Consultants Studies Foundation shows that in Italy [20], in May 2021, almost half of the employed working from home (48.3%, estimated at 2.6 million employees) complained of the onset of problems physical resulting from this aspect; an element that is particularly accentuated among men (50.4%) and among young people, where 53.6% report this type of problem. This is a fact attributable to the presumed less attention in compliance with procedures and precautions aimed at protecting health, which grows in contrast with advancing age, but also to the more frequent movement to workplaces other than one’s home, which presumably present greater limits in terms of safety and suitability of the workstations.

Another aspect worthy of attention, for the implications in terms of health and well-being of the worker, is the increase in work stress, generated by the dilation of time, by performance anxiety, by the weakening of company relations, all aspects highlighted by the survey cited as a direct consequence of the use of agile work and which together can contribute to causing an increase in work-related stress and particular pathologies connected to it. According to this survey, almost half of smart working workers complain of greater stress and performance anxiety. Even the distortion of relationships with colleagues, bosses, customers, based on physical distancing, in the long-run has counterproductive effects for about one worker out of two: 49.7% in fact report the worsening of the climate in the company, the weakening of working relationships; 47% feel marginalized with respect to the dynamics of organizations, while about 40% begin to report real disaffection towards work. Finally, about a third (33%) declare that remote work is penalizing their career and professional growth.

The digitization of the way the work is carried out must therefore be considered for what it really is: it is not the mere introduction of new technical and organizational tools, but the promotion of a real context, a different environment that determines an overall impact on conditions of work and can lead to opportunities and problems at the same time. In general, the analysis of the trend in these months of progressive exit from the pandemic of accidents at work, occupational diseases, and the impact of smart working and work stress confirms that in this historical phase it is very important to avoid changes in the work induced by the economy compromise the conditions of well-being, human relations, and the reconciliation between lifetimes and work times. The challenge of well-being at work is the factor that goes with a decrease in the risk of accidents and illnesses. This is true in Italy as in the rest of Europe.