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26 August 2011

Occupational health

Occupational health refers to the identification and control of the risks arising from physical, chemical, or other workplace hazards in order to promote a safe and healthy working environment. These hazards may include chemical agents and solvents, heavy metals (such as lead and mercury), physical agents (such as loud noise or vibrations), and physical hazards (such as electricity or dangerous machinery, such as power saws and meat slicers). Occupational health also involves psychological factors such as work-related stress. The severity of occupational health problems varies greatly, from mild carpal tunnel syndrome to potentially fatal disorders (such as black lung disease) and fatal work-related accidents.

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BACKGROUND

Occupational health refers to the identification and control of the risks arising from physical, chemical, or other workplace hazards in order to promote a safe and healthy working environment. These hazards may include chemical agents and solvents, heavy metals (such as lead and mercury), physical agents (such as loud noise or vibrations), and physical hazards (such as electricity or dangerous machinery, such as power saws and meat slicers). Occupational health also involves psychological factors such as work-related stress. The severity of occupational health problems varies greatly, from mild carpal tunnel syndrome to potentially fatal disorders (such as black lung disease) and fatal work-related accidents.

Examples of more hazardous occupations include farming, fishing, logging, mining, truck driving, construction, healthcare, and public safety (such as firefighters and law-enforcement officers). People in such occupations may be asked to pay higher premiums for accident insurance or life insurance.

Two common work-related musculoskeletal problems are back strain and carpal tunnel syndrome; the latter typically causes pain, weakness, or numbness in the hand and wrist. The U.S. Department of Labor's Bureau of Labor Statistics (BLS) reports that among cases of carpal tunnel syndrome that required days away from work in 2007, the average number of days missed was 28. Among back injuries that required days away from work, the average number of days missed was only seven.

According to the BLS, there were more than four million nonfatal work-related injuries and illnesses in the United States in 2007. The BLS defines occupational injury as "any injury such as a cut, fracture, sprain, or amputation that results from a work-related event or a single, instantaneous exposure in the work environment." It defines occupational illness as "an abnormal condition or disorder, other than one resulting from an occupational injury, caused by exposure to factors associated with employment." The World Health Organization (WHO) estimates that occupational risk factors are responsible for more than one-third of back pain cases and about one-sixth of hearing loss cases across the globe.

Some types of occupational injuries and illnesses may be deadly. The BLS reports that in 2007, more than 5,600 Americans died from work-related injuries, including over 500 people in Texas alone. In addition, a 2003 study by scientists at the U.S. National Institute for Occupational Safety and Health (NIOSH) estimated that nearly 50,000 Americans die each year from work-related diseases. Such diseases include chronic obstructive pulmonary disease (COPD), certain cancers (such as lung cancer from inhaling diesel fumes and bladder cancer from exposure to certain chemicals used in the dye, rubber, and leather industries), and some cases of cardiovascular disease. According to estimates by the WHO, more than 300,000 people worldwide die each year from work-related injuries, and another 1.7 million die from work-related diseases.

A disproportionate share of occupational injuries and illnesses occurs in developing countries, where laws protecting workers' health and safety may be weaker than in more industrialized countries.

The U.S. Occupational Safety and Health Administration (OSHA), an agency of the U.S. Department of Labor (DOL), develops and enforces minimum standards for workplace safety and health in the United States. OSHA reported in 2007 that since the agency's creation in the early 1970s, occupational deaths have declined by about 60%, and injuries have decreased by about 40%. Yet, organized labor and even the DOL have criticized OSHA for lax enforcement of its own rules during recent years. The current Labor Secretary, Hilda Solis, has pledged to toughen OSHA enforcement by hiring more inspectors.

The global economic recession of 2008 and 2009 may be having a mixed impact on workers' health and safety. On the one hand, employees of companies that have reduced staff positions may face increasing job demands that not only increase work-related stress, but also put them at greater risk of work-related injuries. Struggling companies may devote fewer resources to workplace safety and may outsource more work to independent contractors, who are not offered health benefits. On the other hand, preliminary figures for fatal occupational injuries in the United States in 2008 indicate fewer such fatalities than in 2007. One reason is that some industries that have historically accounted for a significant share of worker fatalities (such as construction) experienced large declines in employment.

TECHNIQUE

Surveillance :

General: Statistical information on occupational health and safety is used to guide efforts to improve worker safety and health and to monitor trends and progress over time.

United States: The U.S. Department of Labor's Bureau of Labor Statistics (BLS) compiles data on work-related injuries, illnesses, and fatalities. The BLS's Census of Fatal Occupational Injuries uses various state, federal, and independent data sources to identify, verify, and describe fatal work injuries during each calendar year. The BLS's Survey of Occupational Injuries and Illnesses counts nonfatal workplace injuries and illnesses reported by employers. The survey does not include workers at federal, state, and local government agencies, in part because only about 30 U.S. states and territories collect data on injuries and illnesses among workers in state and local governments.

Cases of occupational illness may be undercounted, and official records are not kept for deaths from occupational diseases. Figures for such deaths are generally estimates based on expert opinion. Because most diseases that can be caused by occupational exposures may also have non-occupational causes, it may be difficult to determine how much work-related exposures contributed to a particular ailment, much less whether these exposures actually caused a death. Another factor hindering the accurate counting of occupational illnesses is the long latency period between exposure to workplace toxins and the development of cancer and some other diseases. Many workers may have already retired before their illnesses were diagnosed.

Worldwide: According to the World Health Organization (WHO), data on occupational health and safety indicators, such as work injuries and occupational diseases, are collected in some form by nearly every country. It is difficult to compare data between countries because of differences in legislation, criteria, and reporting systems.

Regulation :

General: In the United States, federal and state governments enforce minimum standards for workplace safety and administer workers' compensation programs. Worldwide, occupational health regulations vary from country to country.

OSHA: The U.S. Occupational Safety and Health Administration (OSHA), an agency of the U.S. Department of Labor, was created under the Occupational Safety and Health Act (OSH Act), which was signed by President Richard Nixon on December 29, 1970. OSHA's mission is to prevent work-related injuries, illnesses, and deaths by developing and enforcing minimum standards for workplace safety and health.

The OSH Act allows U.S. states to develop their own safety and health programs, as long as their standards are at least as protective as OSHA's minimum standards. State-run plans can address specific hazards found in local industries. As of September 2009, about 25 U.S. states and territories had their own safety and health programs; the remaining states use OSHA's standards.

All employers must post the OSHA safety poster (or that of a state-run program) to provide their employees with information on their health and safety rights. Such posters include contact information for reporting hazardous working conditions.

To enforce its standards, OSHA conducts inspections of workplaces. Inspection priorities include imminent dangers, fatalities or accidents resulting in hospitalization of three or more employees, employee complaints, high-hazard industries or occupations (such as trenching or operating mechanical power presses), and follow-up inspections of workplaces previously cited for serious violations.

Companies can be fined for violating OSHA standards. In rare cases, company officials have served jail time when willful violations of OSHA standards resulted in a worker's death.

In March 2009, the Department of Labor's Office of the Inspector General issued a report finding significant problems in OSHA's Enhanced Enforcement Program, an initiative launched in 2003 and intended to improve safety at companies with a history of job-related fatalities. The report said OSHA did not follow correct procedures in 97% of 282 sampled cases. It also suggested that proper enforcement could have "deterred and abated workplace hazards at the worksites of 45 employers where 58 subsequent fatalities occurred." The report recommended that OSHA take steps to target "indifferent employers most likely to have unabated hazards" and to ensure that follow-up inspections are conducted.

Workers' compensation: Both federal and state governments administer workers' compensation programs that provide wage replacement benefits, medical treatment, vocational rehabilitation, or other benefits to employees or their dependents who are injured at work or acquire an occupational disease. When injured or ill employees are reimbursed for medical expenses, workers' compensation functions as a form of health insurance. Employees may or may not have other health insurance.

According to news reports, wage replacement benefits don't necessarily match a worker's usual wage, and there can be long delays in getting benefits. Research dealing with workers injured on the job in New York State during 2004 and 2005 found that only 29% of claims received first payment within 21 days of the injury. To reduce workers' compensation costs, some employers discourage employees from filing claims and may even fire those who do. Studies suggest that workers' concerns about retaliation have contributed to a decline in the number of compensation claims in New York State and throughout the United States in recent years.

Worldwide: The WHO Global Plan of Action on Workers' Health, covering 2008 to 2017, has several main objectives: to strengthen the leadership capabilities of national health systems; to respond to the health needs of working people; to establish basic levels of health protection at all workplaces; to ensure access of all workers to preventive health services; to raise awareness about workers' health; and to encourage the incorporation of workplace health issues into other policies, such as sustainable development, poverty reduction, and trade liberalization. Member countries have agreed to develop national action plans to support these objectives.

THEORY/EVIDENCE

More hazardous occupations and industries :

General: Workers involved in manufacturing or processing hazardous materials (such as poisonous chemicals or nuclear waste) are at risk for exposure to these substances. Examples of other occupations or industries that tend to pose health risks are described below.

Construction work: Construction work includes many inherently hazardous tasks and conditions, such as working at heights, working in excavations, using power tools and other equipment, and working with electricity. It may also include hazardous elements, such as noise, dust, chemicals (e.g., arsenic preservatives, lead coating, and solvents), and poorly ventilated confined spaces. Demolition construction may expose workers to older insulation materials, such as asbestos, polychlorinated biphenyls (PCBs), and formaldehyde.

Farming: According to the U.S. National Institute for Occupational Safety and Health (NIOSH), farmers are at high risk for fatal and nonfatal injuries, work-related lung diseases, noise-induced hearing loss, skin diseases, and certain cancers associated with chemical use and prolonged sun exposure. Farming is one of the few industries in which the families (who often share the work and live on the premises) are also at risk for injuries, illness, and death.

Several recent studies have linked ongoing exposure to pesticides among agricultural workers to an increased risk for developing Parkinson's disease. For example, a study appearing online in April 2009 in the Annals of Neurology found that male agricultural workers exposed to organochlorine insecticides had more than twice the risk of Parkinson's as men with no exposure.

A 2008 report by the U.S. Centers for Disease Control and Prevention (CDC) found that the rate of heat-related deaths among crop workers (most of them born outside of the United States) was 20 times higher than the rate for the general workforce. One possible explanation is that crop workers often wear extra clothing and personal protective equipment to reduce the risk of pesticide poisoning.

A 2007 study in Austria found that farmers are more likely than non-farmers to have chronic obstructive pulmonary disease (COPD), even after taking smoking into account. Exposure to mineral dusts stirred up by working the soil could contribute to COPD. (The study did not examine whether certain types of farming are more hazardous than others.)

Fishing: Risks include vessels sinking or capsizing, falls (on deck or overboard), being entangled in or struck by equipment, cuts from gutting fish, and carpal tunnel syndrome from highly repetitive tasks, such as cutting and trimming the fillets.

Healthcare work: Notable hazards are infections (including pandemic flu), needle-stick injuries, back injuries (from lifting patients), latex allergies, violent patients (in psychiatric wards and emergency rooms, for example), and long working hours. Because of their contact with patients who have infectious illnesses, it is important for healthcare workers to stay up to date on their vaccinations.

Logging: Safety concerns in logging include the use of chainsaws and logging machines, proximity to falling and rolling trees and logs, exposure to harsh weather, and remote worksites where healthcare facilities are not immediately available.

Mining: Possible causes of mining injuries include rock falls, fires, explosions, and falls from heights. Constant noise poses the threat of noise-induced hearing loss. Miners have high rates of back and knee pain due to heavy lifting and working in often cramped conditions. Coal workers' pneumoconiosis, also called black lung disease, is a disabling and potentially fatal disorder caused by inhaling excessive amounts of coal dust. Mining or cutting through materials that contain the compound silica, including granite, quartz, and sandstone, generates silica dust. Breathing excessive levels of this dust may lead to silicosis, another disabling and potentially fatal lung disease. While protective equipment such as respirators may help prevent these respiratory diseases, proper ventilation and other methods to reduce dust levels in mines are also important.

Public safety work: Firefighters are at risk for burns, inhalation of smoke or toxic gases, falls due to collapsing structures, being hit by falling objects, and heat exhaustion. A study presented at a March 2009 meeting of the American Heart Association suggests that firefighters have an increased risk of prematurely narrowed arteries, increasing their risk of strokes and heart attacks. Exposure to particulate matter in smoke may play a role.

Law enforcement officers may contend with life-threatening violence. Emergency medical technicians may experience back strain or other injuries due to heavy and awkward lifting, and they are at risk of infection with blood-borne viruses such as hepatitis B and C and human immunodeficiency virus (HIV). Because public safety workers operate under extreme time pressures, they are also at increased risk for motor vehicle accidents.

Truck, bus, and related driving: People who drive for a living are not only at risk for motor vehicle accidents. Back problems are common from prolonged sitting or poorly designed seating. Truck and bus drivers may experience lifting injuries from loading or unloading cargo or baggage. They may also be exposed to toxic chemicals from mechanical problems or emissions during loading or unloading. Eating out frequently may contribute to poor nutrition among some long-distance drivers. Additionally, some long-distance drivers may use habit-forming stimulant drugs to fight fatigue. In some countries, truck drivers (who work alone for long periods away from home) are frequent clients of prostitutes and are among the main vectors for transmitting HIV.

HEALTH IMPACT/SAFETY

Work-related deaths :

General: Work-related deaths may be due to traumatic injuries or to diseases caused by exposure to toxic substances or other risk factors. According to the World Health Organization (WHO), 1.7 million people die each year from work-related diseases. A WHO analysis estimated that occupational risk factors caused 318,000 deaths from chronic obstructive pulmonary disease (COPD) in 2000, 102,000 deaths from lung cancer, 38,000 deaths from asthma, and 7,000 deaths from leukemia.

Traumatic injuries: The U.S. Bureau of Labor Statistics (BLS) reports that 5,657 people died from work-related injuries in the United States in 2007 (the most recent year for which final results are available). That is an average of 15 deaths each day.

The most frequent work-related fatal events in 2007 were highway incidents (1,414 deaths), falls (847), homicides committed by disgruntled former employees or others (628), and being struck by an object (504). More than one-third of the fatal falls were from a roof or ladder.

Although the construction industry had the highest number of fatal injuries (1,204) in 2007, other industries with high fatality rates were agriculture, forestry, fishing, and hunting (27.9 fatalities per 100,000 employed) and mining (25.1).

Driver/sales workers (those with sales and customer service responsibilities) and truck drivers were the occupations with the largest number of fatal work injuries in 2007. Their 976 fatalities accounted for about one in six of all on-the-job fatal work injuries.

The occupations with the highest rates of fatal work injuries in 2007 were fishers and related fishing workers (111.8 fatalities per 100,000 employed), logging workers (86.4), aircraft workers and flight engineers (70.7), structural iron and steel workers (45.5), and farmers and ranchers (39.5).

The rate of fatal injuries for all U.S. workers in 2007, 3.8 fatalities per 100,000 workers, was the lowest since figures were first kept in 1992, reports the BLS.

According to the WHO, more than 300,000 people die each year from work-related injuries.

Occupational diseases: A 2003 study by scientists at the U.S. National Institute for Occupational Safety and Health (NIOSH) attributed 49,000 annual deaths (or 134 a day) to work-related diseases caused by exposure to toxic substances or other risk factors. First, researchers identified diseases for which an occupational association is reasonably well established. For each disease, they estimated the proportion of deaths attributable to occupation: For example, all deaths from coal workers' pneumoconiosis (black lung disease) were assumed to be occupational in origin, while only 2.5-5% of all cancer deaths were thought to be due to occupational exposures. Then, researchers estimated the number of occupational deaths by disease, using U.S. mortality data from 1997.

Respiratory diseases: According to the 2003 NIOSH report, about 16,000 deaths a year were attributed to work-related respiratory diseases (excluding lung cancer). That included 14,257 deaths from chronic obstructive pulmonary disease (COPD) due to occupational dust exposure; 784 deaths from asthma caused by exposure to dusts, gases, vapors, or fumes in the workplace; 486 deaths from coal workers' pneumoconiosis due to inhaling coal dust; 405 deaths from asbestosis due to inhaling asbestos fibers; and 92 deaths from silicosis due to inhaling silica dust.

Cancer: According to the 2003 NIOSH report, 12,682-26,244 cancer deaths a year were attributed to workplace carcinogens. That included 9,677 to 19,901 lung cancer deaths from inhaling arsenic, asbestos, cadmium, diesel fumes, radon, secondhand smoke, silica, or other substances; 1,895 to 2,366 deaths from mesothelioma, a rare cancer that affects the tissue lining the lungs and other organs and that is related to asbestos exposure; 651 to 2,191 bladder cancer deaths from exposure to organic compounds called aromatic amines that are used in the dye, rubber, leather, and other industries; 231 to 322 nasal cancer deaths from exposure to wood dust, nickel compounds, or other substances; 152 to 533 leukemia deaths from exposure to certain chemicals (benzene, ethylene oxide) or ionizing radiation; and 30 to 603 laryngeal cancer deaths from exposure to sulfuric acid or certain mineral oils.

Coronary heart disease: According to the 2003 NIOSH report, 4,500-12,900 annual deaths from coronary heart disease were attributed to occupational risk factors, such as lack of job control (which boosts stress), secondhand smoke, shift work (linked to hormonal and metabolic changes that may increase the risk of diabetes and obesity), and even excessive noise (which can raise blood pressure).

Kidney disease: According to the 2003 NIOSH report, 328-580 annual deaths from kidney disease (excluding kidney cancer) were attributed to occupational exposure to silica, organic solvents, lead, or cadmium.

Liver disease: According to the 2003 NIOSH report, about 200 deaths a year from liver diseases, including liver cancer, nonalcoholic cirrhosis, and chronic hepatitis, were attributed to hepatitis B and C infections among healthcare or other workers.

Nonfatal work-related injuries and illnesses :

General: According to the BLS, more than four million cases of nonfatal workplace injuries and illnesses were reported by private industry employers in 2007. More than half of these cases were serious enough to require a job transfer, work restrictions, or time away from work.

Sprains, strains, and tears were the most common types of injury or illness involving days away from work in 2007, accounting for nearly 40% of such injuries and illnesses. Other common injuries or illnesses were bruises and contusions, fractures, cuts and lacerations, heat burns, punctures, and carpal tunnel syndrome. The part of the body most often affected by work injuries was the trunk (including the shoulder and back), accounting for 33% of all injuries and illnesses.

According to the BLS, 10 occupations had at least 20,000 injuries and illnesses that required days away from work in 2007: laborers and freight (cargo), stock, and material movers (79,000); heavy and tractor-trailer truck drivers (57,050); nursing aides, orderlies, and attendants, all of whom provide basic patient care under the direction of nursing staff (44,930); construction laborers (34,180); light or delivery service truck drivers (32,930); retail salespersons (32,920); janitors and cleaners (30,060); carpenters (23,800); maintenance and repair workers (23,460); and registered nurses (20,020). These 10 occupations made up 33% of all days-away-from-work injuries and illnesses in 2007.

The WHO estimates that occupational risk factors are responsible for 37% of back pain worldwide and 16% of hearing loss.

According to the WHO, studies suggest that psychosocial hazards and work-related stress affect one-fifth of the working population in industrialized countries.

Reducing risk: According to the U.S. Occupational Safety and Health Administration (OSHA), workers can reduce occupational health risks by reading the OSHA poster in their workplaces; following the employer's safety and health rules; wearing or using all required gear and equipment (even if these items do not offer total protection); following safe work practices for the job (as directed by the employer); reporting hazardous conditions to a supervisor or safety committee; and reporting hazardous conditions to OSHA, if the employers do not fix them. The NIOSH suggests that employees may reduce work-related stress by improving time-management skills, practicing relaxation techniques, and communicating with managers about stressful aspects of work such as excessive workloads and unclear expectations.

FUTURE RESEARCH OR APPLICATIONS

Tougher enforcement by OSHA: In June 2009, U.S. Labor Secretary Hilda Solis said that her department would strengthen the Occupational Safety and Health Administration (OSHA) by adding more than 100 inspectors. She said that OSHA would focus on the construction industry in particular. An inspector who sees scaffold, fall, trenching, or other hazards can launch an immediate investigation.

More accurate workplace fatality rates: In August 2009, the workplace fatality rates calculated by the U.S. Bureau of Labor Statistics (BLS) began taking into account the number of hours worked by people in specific occupations or industries. Previously, fatality rates were based on the number of people in a particular occupation or industry during a given period of time, regardless of hours worked. The new figures should be more accurate for groups of workers who tend to work part-time, such as young workers (who have higher rates of workplace injuries than older workers).

Resurgence of black lung disease: One area for future research is why coal workers' pneumoconiosis (black lung disease) has increased in recent years, after decades of steady decline. A September 2007 report found the disease rate among miners who had worked at least 25 years underground more than doubled between 1997 (four percent) and 2006 (nine percent). The rate among miners with 20-24 years of experience jumped even more, from 2.5-6%. One possible factor is that longer work hours may be increasing workers' exposure to coal dust.

Healthcare workers and pandemic flu: A report released in April 2009 by the American Federation of Labor and Congress of Industrial Organizations (AFL-CIO) and several unions warned that many U.S. healthcare facilities are not prepared to protect healthcare workers from exposures to pandemic influenza, putting both care providers and the general public at risk. Preparedness in other countries was not covered in the report, but developing nations are likely to be even less ready to protect their healthcare workers.

AUTHOR INFORMATION

This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

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Copyright © 2011 Natural Standard (www.naturalstandard.com)
 
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