Most organisations can describe their LTIs to the day. They can list first‑aid cases, medical‑treatment injuries, even fatalities. But the most common and costly harms in desk‑based work often arrive quietly – through cumulative exposure: long sitting bouts, constrained postures, high interruption load, and thin recovery between tasks. These don’t fit cleanly on an incident form, and that’s precisely the problem.

The thesis: fairness and prevention

There’s a measurement blind spot in how we treat “health” versus “safety”. Acute, visible events are counted and compensated; chronic, gradual harms are under‑reported and often borne by individuals. The answer is not to abandon injury metrics – it’s to add exposure indicators alongside them and to redesign the workday to reduce foreseeable harm at source. Duty of care means change the work, not police lifestyles. [1–3] For desk‑based roles, MSDs are the most occupationally proximate outcome; cardiometabolic risk is the broader health envelope.

Risk = exposure × susceptibility

Chronic outcomes are multifactorial. Lifestyle affects susceptibility (sleep, fitness, health conditions). Work design drives exposure (how long we sit without moving; how often we’re interrupted; whether recovery is possible). Employers don’t control everything, but they do control exposure. That’s where prevention should start. [2,3]

What the evidence says (in brief)

• Under‑reporting and attribution. In compensation systems that emphasise a single incident, gradual‑onset musculoskeletal disorders (MSDs) are frequently under‑recognised – even though the work contribution can be substantial. [1]

• Burden in desk‑based work. Among office workers, 12‑month low‑back‑pain prevalence commonly sits around one‑third to one‑half of staff – a material signal of cumulative exposure in sedentary roles. [6]

• In‑work change works. Multicomponent programmes that change in‑day exposure – for example, sit–stand options plus guidance to break up long sitting – reduce at‑work sitting and improve secondary outcomes over 12 months. The point isn’t a perfect posture; it’s a better cadence. [4]

• Health belongs in “safety”. WHO/ILO joint estimates show disease accounts for the majority (~81%) of work‑related deaths, led by long working hours (ischaemic heart disease, stroke) and respiratory/cardiovascular exposures. “Sedentary” isn’t apportioned as a separate risk factor in that model – another reason to track exposure inside the workday locally. In desk‑based roles, long working hours often co‑occur with prolonged sitting, compounding cardiometabolic risk and magnifying MSD risk via reduced recovery—two reasons to address both cadence and sitting exposure together. [2][5] Reducing prolonged sitting and restoring recovery time likely benefits both MSD and cardiometabolic risk – two pathways, one set of in‑day controls.

• Sedentary behaviour and pain. Systematic reviews link sedentary behaviour with musculoskeletal pain – particularly neck/shoulder symptoms – underscoring the need to reduce long, unbroken sitting bouts. [5]

Inside the slow harm.

Desk work loads the body in quiet ways: long, unbroken sitting reduces tissue perfusion and spinal disc nutrition; constrained neck/shoulder postures keep low-level muscle activity switched on; interruptions and time pressure increase co-contraction and shorten recovery; and long hours limit sleep, amplifying pain sensitivity and fatigue. None of this hits an incident log—but over months it shows up as rising neck/shoulder/low-back discomfort and reduced capacity. That’s why in-day exposure change matters.

Mind the metric gap

Most dashboards obsess – rightly – over LTIs, MTIs and first‑aid. The fix is additive: keep what’s working and add health‑exposure signals that leaders can influence.

• Prolonged sitting exposure: % of staff with ≥1 sitting bout >60 minutes per day (trend).

• Recovery cadence: buffer minutes between meetings; micro‑breaks per day.

• Interruption load: notifications per hour during focus time.

• Ergonomic readiness: % of hybrid staff with suitable equipment + verified set‑up across locations.

• Discomfort prevalence: pulse check for neck/shoulder/low back.

These are practical, privacy‑respecting, team‑level indicators that guide design decisions without surveilling individuals. In desk‑based work, the harm most often shows up as years lived with disability (DALYs) rather than lost time or fatalities. While DALYs aren’t practical to track at company level, keep this burden in view by tracking simple team‑level proxies (exposure + discomfort prevalence) over time.

The dual lens leaders need

Think binoculars, not a monocle. Two lenses bring MSD risk into focus:

• Lens 1: Biomechanics (equip & set). Ensure the foundation: essential kit (chair, screen elevation, external keyboard/pointing device), competent set‑up for neutral joint positions, and posture change made easy. In hybrid work, standards must travel with the worker (home, office, hot‑desks), supported by portable equipment where needed.

• Lens 2: Work design (shape cadence & recovery). Protect the gains of good ergonomics by designing the day: default 25/50‑minute meetings, short buffers and micro‑breaks.

Posture‑first—not posture‑only. Biomechanics lowers baseline load; cadence and recovery ensure those gains hold under real‑world pressure. [3,4,5]

Costs and equity

Safe Work Australia’s burden work shows the largest share of costs falls on individuals, then society, with organisations bearing the smallest fraction directly. That asymmetry is exactly why leaders should act upstream: if we count days lost to incidents, we should also design down exposures that drive slow harm—because the bill eventually arrives as lost capacity, presenteeism, chronic pain, and silent exits. Australia also loses ~41,000 working years annually to compensable injury and disease, about one‑fifth due to musculoskeletal disorders. [1,4,7,8]

How to start (practical, not theoretical)

You don’t need a perfect dashboard to begin. Pick signals, run a four‑week pilot in two teams, and review together.

1. Choose signals: prolonged sitting bouts; ergonomic readiness; buffer minutes between meetings; discomfort pulse checks.

2. Nudge the environment: 25/50‑minute defaults, auto‑buffers, equipment check‑ins.

3. Review & adapt: track trends, not targets; tighten what helps, drop what doesn’t.

The aim is momentum, not surveillance: exposure steadily down; comfort and capacity steadily up.

Close: two dashboards, one duty

We will always treat injuries. The leadership test is whether we redesign the workday so fewer people are injured slowly. Keep the incident metrics; add exposure metrics. Equip and set first; shape cadence and recovery next. That’s how “health” takes its rightful place inside “safety”.

References

[1] Safe Work Australia. Work‑related musculoskeletal disorders (under‑reporting/gradual onset context).

[2] WHO/ILO. Joint Estimates of the Work‑related Burden of Disease and Injury (disease share; long working hours → IHD/stroke).

[3] ISO 45003:2021 – Psychological health and safety at work: Guidelines for managing psychosocial risk.

[4] Edwardson CL, et al. SMArT Work cluster RCT: reducing at‑work sitting with multicomponent interventions. BMJ. 2018.

[5] Dzakpasu FQS, et al. Sedentary behaviour and musculoskeletal pain: systematic review/meta‑analysis. Int J Behav Nutr Phys Act. 2021.

[6] Janwantanakul P, et al. Risk factors and 12‑month LBP prevalence in office workers: systematic review. J Manipulative Physiol Ther. 2012.

[7] Safe Work Australia. Economy‑wide burden: CGE modelling of injury/illness costs (e.g., ~$28.6b GDP; ~185,500 jobs).

[8] Lane TJ, et al. Working years lost due to work‑related injury and disease, Australia 2012–2017. Med J Aust. 2020.