143 Context analysis of interventions among lower socioeconomic position employees Insufficient Investments in Prevention by Employers The majority of the stakeholders acknowledged that prevention of health problems and (long-term) sick leave is an important priority. However, some stakeholders also mentioned that much more attention is needed for prevention than currently is the case, also in the education of health professionals. Several stakeholders, including trade organizations themselves, mentioned that trade organizations can play an important role in increasing the attention for prevention in organizations. Preventive services that are offered in an organization depend on the contracts between an employer and OHS. Several stakeholders representing all three levels described that preventive services are often not included in the basic contracts, and that basic contracts mainly focus on the guidance of employees on long term sick leave: S8 (socio-political macro level): “The occupational health service or the occupational physician, they have a contract with the employer, only within that contract there is actually very little arranged in the field of prevention, unfortunately it is mainly about the guidance of employees on sick leave, while we would like to see that prevention is also part of that contract, only that happens far too little and we think that’s a shame.” In addition, some stakeholders representing trade organizations stated that there is less attention for prevention in contracts due to the Gatekeepers Act. This law shifted the attention from prevention to the guidance of employees on sick leave. Another reason, mentioned by some stakeholders representing OPs, is that OHPs are not always involved in the formation contracts between an OHS and employer. OHPs that are more involved in this process are more likely to be used for preventive services in organizations. Stakeholders described several reasons for employers to spend money on prevention. According to the majority of the stakeholders, financial resources play a major role in the decision to implement preventive services. Smaller organizations or organizations in an economic crisis (e.g. due to the Covid-19 pandemic) have less resources (time and money) to invest in preventive services. As a result, employers first invest in services that focus on the guidance of employees on long term sick leave. Second, stakeholders mentioned that employers who do not see their employees as valuable, also tend to invest less in prevention. Third, the extent to which the results of prevention are visible and provide a return on investment is also important for the majority of the stakeholders. But, the results of prevention are often unclear, and these results cannot always be quantified, making it hard to convince employers to invest in prevention. Fourth, some stakeholders at OHS and socio-political macro level stated that employers focus on short term results as they are not or less aware 5
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