Occupational Health

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Occupational Health

• 16 deaths per day
• http//www.youtube.com/watch?vpssw5bnjnr4
• Matewan (union meeting)
• http//www.youtube.com/watch?vqwEMIvDEFy4
• Young Worker injury
• http//www2.worksafebc.com/Publications/Multimedia
  /Videos.asp?ReportID34939
• Triangle Shirtwaist Fire The Race to the
  Bottom
• http//www.usw.org/media_center/news_articles?id0
  739

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Introduction

• Occupational disease any abnormal condition or
  disorder, other than one caused by occupational
  injury, caused by work-related factors.
• Occupational injury injury resulting from
  exposure resulting from a single incident in the
  work environment.

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Scope of the Problem Global

• 2.6 billion workers
• 250 million occupational injuries/year
• 330,000 fatalities
• 1.1 million worker deaths each year from
  work-related illnesses
• 160 million new cases of diseases resulting from
  the workers environment

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Scope of the Problem U.S.

• 14 people die of work-related injuries each day
  in the U.S. About 5000 people/yr.
• Fatalities have declined significantly over past
  100 years 23,000 (1913) 14,000 (1968) 4,600
  (2010).
• Economic impact of occupational injuries,
  illnesses, and deaths 142 billion in 2006.
• Importance of occupational safety and health to
  the community ? safety and health of surrounding
  community is closely linked to workplace safety
  and health.

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History of Occupational Safety and Health Problems

• 1561 De Re Metallica (G. Agricola) mining
  hazards, need for ventilation)
• 1700 Discourse on Diseases of Workers
  (Ramazzini)
• Industrial Revolution
• State legislation
• Child labor laws
• Workers compensation laws
• Federal legislation
• Bureau of Labor (1884)
• Many related laws from 1908 to 1970
• Occupational Safety and Health Act of 1970

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Highlights of Federal Occupational Safety and
Health Legislation
Year Legislation
1908 Federal Workmens Compensation Act (limited
coverage) 1916 Federal Highway Aid
Act 1926 Federal Workmens Compensation Act
(included workers) 1927 Federal Longshoremens
Harbor Workers Compensation Act 1936 Walsh-Healey
Public Contracts Act 1952 Coal Mine Safety
Act 1959 Radiation Standards Act 1960 Federal
Hazardous Substances Labeling Act 1966 National
Traffic Motor Vehicle Safety Act Child
Protection Act (banned hazardous household
substances) 1967 National Commission on Product
Safety created 1968 Natural Gas Pipeline Safety
Act 1969 Construction Safety Act Coal Mine
Health Safety Act 1970 Occupational Safety
Health Act 1986 Worker Right to Know Act (part of
SARA, Superfund II)
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Industrial Revolution

• Serious environmental and workplace health/safety
  problems.
• Govt. and industry did little.
• Earliest unions take on H S issues
• (e.g. Knights of Labor, Industrial Workers of
  World) take on H S.
• Struggles over community and worker health ?
  started first in community, led by activists with
  access to legal and scientific assistance.

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Progressive Era (1890-1920)

• Community/worker health struggles.
• Started in communities, led by activists linking
  to legal, scientific assistance. Mining, textile
  mills, foundries
• Alice Hamilton (1869-1970)
• Health researcher, came out of settlement
  movement (middle/upper class women, promoted
  better housing, sanitation, public health)
• Workers Health Bureau (1920s)
• Organized by women activists to promote worker
  health and safety

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Those who know dont tell (film about worker
health and safety)

• Why do companies hide the truth? (about cause of
  worker death/injury, information/knowledge about
  chemicals, etc.)
• Its cheaper not to tell. Workers are too
  fearful to protest. It would damage company
  reputation.
• Instead, companies push the cost of health onto
  society ? they externalize the cost to the
  workers and society.

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Those who know dont tell (film about worker
health and safety)

• In late 19th century/early 20th century, workers
  were getting sick and dying. Govt. did nothing.
  Workers protested.
• Employers take safety short-cuts. e.g. boss turns
  off air monitor alarm in microchip plant, so that
  workers will continue working.
• Not enough safety focus in workplaces.
• Hawks Nest/Gauley Bridge disaster (1931-32)
  workers dropped dead of acute silica inhalation.
• Workers rely on themselves to monitor air and
  their health.
• Alice Hamilton was early health and safety
  crusader.

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Those who know dont tell (film about worker
health and safety)

• When a worker died, the company would typically
  hide the cause of death.
• Workers join together to change things unions,
  workers, community, public health activists.
• Mules got treated better than workers.
• Established unions (United Mineworkers,
  Steelworkers, Chemical Workers) gained control of
  hazards, pushed for better conditions.
• Accident prevention can happen with a more
  educated staff, including production workers.
• Occupational health doctors advanced in 1970s, as
  some unions (Oil, Chemical and Atomic Workers,
  United Steelworkers) trained them.

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Matewan (film by John Sayles, 1988)

• Coal mine conflict (Coal Wars), 1920-21, West
  Virginia.
• Companies, together with government, sought to
  break the unions and their organizing efforts.
• Joe is a union organizer, trying to unite local
  whites, African-Americans, Italian immigrant
  workers.
• Joe tries to help workers see their class
  interests (the workers work, management doesnt).
• Formation of class consciousness that will help
  workers and the union to overcome the companys
  efforts to divide and conquer the workers.

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Solidarity

• Both Those who know dont tell and Matewan
  demonstrate that an injury to one is an injury
  to all. ? the basic message of the labor
  movement and the worker health and safety
  movement in the U.S.
• An injury to one is an injury to all
  solidarity on part of workers and communities for
  one another.

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Alice Hamilton, workplace health researcher
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Resurgence of Health and Safety Reform/Activism
(1950s-60s)

• Irving Selikoff medical research on asbestos
  hazards.
• Mining hazards, accidents, illnesses.
• Haphazard state regulations.
• 14,000 deaths/year.
• 1960s social movement era (civil rights,
  environmentalism) pushed along H S reforms.
• Union leadership on H S reform ?
• Oil, Chemical Atomic Workers, United Auto
  Workers

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Irving Selikoff, MD, workplace health researcher
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Irving Selikoff

• Addressed the cover-up by the asbestos industry
  of the long-known hazards of asbestos for
  workers.
• Worked closely with labor unions.
• Helped to develop occupation health clinics.

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Tony Mazzocchi, labor activist,Oil, Chemical
Atomic Workers
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Tony Mazzocchi

• Built coalitions with scientists, public health
  advocates, environmentalists in 1950s against
  atmospheric atomic bomb testing.
• Powered the 1960s movement of labor/environment/pu
  blic health for passage of the OSH Act (1970) and
  creation of OSHA.
• Created training program for doctors to become
  occupational health physicians, bringing together
  medical doctors and labor.
• Forged labor/environmental coalitions throughout
  the 1970s, 80s, 90s.

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Occupational Safety Health Act of 1970

• Purpose to ensure that employers in the private
  sector provide employees with a working
  environment free of recognized hazards that can
  cause death or serious harm. Creates the
  General Duty Clause
• The employer must provide a work environment free
  of recognized hazards ? that is, the employer
  must provide a safe workplace. The employer is
  ultimately responsible for providing a safe
  workplace.
• Employees must work safely.
• Formed Occupational Safety Health
  Administration (OSHA) to create enforce
  occupational standards
• Formed National Institute for Occupational Safety
  Health (NIOSH) research body now in CDC
  recommends standards

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Karen Silkwood, Oil, Chemical and Atomic Workers
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Karen Silkwood

• Whistleblower about sloppy conditions at a
  Kerr-McGee nuclear facility in Oklahoma.
• Killed before she could reveal information about
  corporate deception and health and safety
  shoddiness to a New York Times reporter (1974).
• Her struggle and death demonstrates power of
  corporations to silence whistleblowers and avoid
  accountability.
• An unsung hero for standing up for health and
  safety.

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Key Worker Health and Safety Rights

1. Right to work in a workplace free of recognized
   hazards. The OSHA General Duty Clause employer
   must provide a workplace free of recognized
   hazards.
2. Right to refuse hazardous work.
3. Right to not be discriminated against for
   exercising health and safety rights (e.g. filing
   a complaint).
4. Right to know about health and safety hazards you
   are working with.
5. Right to health and safety training.

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Hierarchy of Controls, Workplace health and safety

1. Eliminate/reduce the hazard (e.g. substitute a
   safer chemical)
2. Engineering controls (e.g. use ventilation to
   remove the hazard)
3. Administrative controls (e.g. work practices such
   shifts or rotations to reduce exposures to
   hazards)
4. Personal Protective Equipment (e.g. respirators,
   suits and gloves)

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Recent Trends in Workplace injuries and illnesses

• Decline in number of injuries and illnesses
  reported in private industry since 1992.
• Goods-producing industries have higher rate of
  non-fatal injury than service-producing.
• Highest agriculture, forestry, fishing,
  hunting.
• Highest service-producing education, health
  care.

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Injuries/fatalities in workplace

• Fatalities 5,214 fatalities (2008)
• 1 cause transportation
• 2 cause struck-by object, caught-in/between
• 3 cause assaults, violent attacks
• 4 cause falls
• Most homicides ? robbery motivated
• Types of injuries
• Motor vehicle crashes, machinery injuries,
  assaults, falls, electrical injuries
• Leading anatomical site hands and fingers.

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Fatal Work-Related Injuries

• Highway incidents leading cause
• Falls, being struck by object, homicide
• Industries with highest rates of fatal
  occupational injuries
• Agriculture
• Forestry
• Fishing and hunting
• Mining
• Transportation and warehousing

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Manner of Fatal Work Injuries, 2008
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Nonfatal Workplace Injury and Illness Incidence
Rates by Industry, 2008
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Nonfatal Work-Related Injuries

• Males account for majority of treatment
• Younger workers highest nonfatal workplace
  injury/illness rate
• Disabling injuries and illnesses
• Repeat trauma disorders

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Characteristics of Workers Involved in
Work-Related Injuries

• Age
• Gender
• Poverty and race
• Geographic differences in workplace injuries
• Temporal variations in workplace injuries
• Workplace injuries by industry and occupation

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Workplace injuries by age

• younger workers (lt25) ? higher rates than older
  workers
• injury death rates highest in oldest workers
  (gt65)
• 100,000 children (many employed illegally)
  injured each year.

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Unintentional Injuries in the Workplace
Number and rate of fatal occupational injuries by
age of worker, 2002.

Data from U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health.
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Hours Worked and Fatal Work Injuries by Gender,
2008
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Most Dangerous Jobs in 2008
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Workplace injuries by gender

• Males injured more than females, every age.
• Men more likely fatally injured than women.
• Homicides ? half of womens work-related deaths

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Workplace injuries by income and race

• Lower socioeconomic groups ? higher death rates
• Injury death rates 12 higher for non-whites than
  whites.
• Highest death rates Native Americans.
• Asian Americans low injury death rates.

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Workplace injuries by geography

• Highest injury death rates in mountain states
  (Wyoming) and Alaska
• Highest farm machinery injuries in North Central
  states.

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Workplace injuries by industry, occupation

• Highest fatality rates mining, fishing,
  agriculture, construction, transportation
• Most dangerous blue collar jobs timber workers,
  crab fishermen

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Workplace Unintentional Injuries Prevention and
Control

• Eliminating or modifying the job
• Changing the work environment
• Making machinery safer
• Improving the selection, training, and education
  of workers

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Workplace Violence

• Homicides are 3rd leading cause of death after
  motor vehicle crashes.
• Homicides are 2nd leading cause of death among
  women workers.
• Most workplace homicides (85) are
  robbery-related.
• Hospitals, nursing homes, social service agencies
  are prone to non-fatal assaults.
• Risk factors working near money/valuables,
  working alone, working late at night.
• Prevention change environmental design, work
  policy, worker behavior.

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Occupational Diseases

• 430,000 cases reported each year.
• 1 Chronic musculoskeletal diseases (trauma to
  muscles, joints, tendons). Leading cause of
  workplace disability. Most costly.
• 2 Dermatological conditions. Contact
  dermatitis, skin cancer, infections.
• 3 Occupational lung diseases. Inhalation of
  toxic substances.

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Occupational lung diseases

• Long latency period
• Pneumoconiosis fibriotic lung disease caused by
  inhalation of dusts
• Asbestosis 1,265 die each year.
• Black lung (coal dust) disease (54)
• Silicosis (crystalline silica), 15.
• Byssinosis (brown lung disease), cotton dust, 20
  deaths.

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Other occupational diseases

• Neurological disorders
• Reproductive disorders
• Cardiovascular disorders
• Cancer deaths, from workplace exposures
• Bloodborne pathogens (big concern for health care
  workers)

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Controlling occupational diseases

• Vigilance of employer, employee, government is
  essential.
• Specific controls needed to control disease.
• Occupational disease control programs require
  trained personnel

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Resources for Prevention of workplace injuries
and diseases

• Safety and health professionals
• Safety engineers and safety professionals ?
  education, correct and remove hazards
• Health physicists ? monitor radiation
• Industrial hygienists ?examine workplace
  environmental factors
• Occupational physicians ? preventive medicine.
• Occupational health nurses

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Resources for Prevention of workplace injuries
and diseases

• Safety and health programs hire and maintain
  healthy workers.
• Pre-placement exams.
• Disease prevention programs control diseases.
• Safety programs reduce injuries.
• Health promotion programs boost morale and
  productivity, reduce medical costs.
• Employee Assistance Programs assist employees
  in overcoming personal problems.

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Prevention and Control of Occupational Diseases
and Disorders

• Agent-host-environment model
• Identification and evaluation of agents
• Procedures
• Engineering controls
• Protective devices
• Surveillance

Host
Agent
Environment
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MassCOSH volunteer testifying at a hearing
calling for a better teen labor law
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Social Movements Create Change

• Labor movement and urban reform movements ?
  raised awareness and built pressure for better
  health and safety conditions at work, Progressive
  Era and later too.
• 1960s social movements created a dynamic to push
  through changes in health and safety laws
  federal OSH Act, Mining Safety Act (MSH Act).
• Social movements respond to disasters (mines,
  plant explosions, fires) ? push through new laws.

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Social Movements Create Change

• Health and safety heroes Alice Hamilton, Tony
  Mazzocchi, Irving Selikoff. Coalition builders
  between unions and public health.
• Environmental/workplace health and safety
  coalitions are important for change, forcing new
  regulations, enforcement. e.g. Workers Health
  Bureau (1920s), OSH Act coalition (late 1960s),
  right-to-know movement (1980s).

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Social Movements Create Change

• Worker and Community Right-to-Know Acts (part of
  SARA (Superfund part 2, 1986) ? resulted from
  broad activism by labor and environmental
  activists.
• Social movements pushed Congress to act ? they
  force regulations into being.
• Tragedies/disasters help spur action, e.g. Bhopal
  chemical release (1984) Farmington, WV mine
  disaster (1968) Sago mine disaster (2006),
  Triangle Shirtwaist Co. fire (1911). But some
  tragedies are quickly forgotten (e.g. Hawks
  Nest)

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Weakness of Social Movements

• Labor union membership has been in decline since
  1960 32 (1960) to 12 (2010), percent of
  workforce in unions.
• While Labor is vocal, it has lost overall
  political clout.
• The environmental movement is weak and
  fragmented, much weaker than when it successfully
  pushed through SARA and Community Right-to-Know
  (1986).

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Failure of Regulation

• Backlash of industry against OSHA regulation
  since 1970s.
• OSHAs power and effectiveness undermined by a
  small budget (smaller than U.S. Fish and Wildlife
  Service).
• Up to 2008, only 1500 OSHA inspectors nationwide
  (Spain has 1500, but 1/6 of the population) ?
  cant do an effective job of enforcing
  regulations. OSHA under Pres. Obama raised OSHA
  inspectors to about 2,400.

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Failure of Regulation

• Industry and Republican administrations, since
  1980, have forced OSHA to move away from
  enforcement of regulations toward voluntary
  compliance with regulations.
• Industry is powerful and will fight back e.g.
  ergonomics standard asbestos research by Dr.
  Irving Selikoff.
• A long, hard effort (10 years) to establish an
  OSHA ergonomics standard (to combat repetitive
  stress injuries) finally succeeded in 2000 (under
  Clinton), only to be thrown out in early 2001 by
  President Bush.

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Summary

• Overall improvement in workplace health and
  safety in U.S. since 1960s, since OSHA Act was
  passed.
• But passage of new regulations and enforcement of
  many current regulations are thwarted, undermined
  by powerful industry elites and their allies in
  federal government.
• The real cost of health and safety (illness,
  injury, fatalities) has been shifted
  (externalized) onto workers, their families and
  communities.

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Summary

• Backlash on workplace health and safety, and
  environmental activism.
• Worker and Community Right-to-Know Acts (1986),
  part of SARA law, were the last substantial
  health and safety and environmental legislation
  in U.S. ? the power of capital (owners of means
  of production) has held labor and
  environmentalism in check.