Chapter 21: Work, Health and Well-Being
Aditi Puri, RHH, MPH, PhD
Learning Objectives
Identify the impact of exposure to workplace hazards on millions of workers who are injured on the job, get sick and die from occupational causes.
Identify the role of governmental agencies in ensuring that employers provide a safe work place to employees.
Identify the significance of interventions in preventing and reducing occupational injury and illness with particular attention to modifiable environmental risk factors resulting from hazardous exposures as well as work policies and practices.
Work and Health
Income from employment provides the material means to obtain basic life necessities such as shelter and food and enables acquisition of desired goods and services.
People who are able to work are generally healthier than those who cannot. Workers with higher incomes have better physical and mental health status and live longer on average than lower wage workers.
Lower income individuals and families tend to have poorer nutrition and reduced educational opportunity, and are more likely to live in polluted or high crime neighborhoods or to be employed in a job that damages their health.
The connection of work to health is a two-way street: unemployment is associated with higher incidence of many diseases, poorer physical and mental health in general, increased hospital admissions and use of medical care, and premature mortality. People who become sick or injured at work are more likely to leave employment and end up sicker.
Work Injuries and Illnesses Impose Heavy Costs on Workers, Families, and the Economy
Globally, someone dies every fifteen seconds from an occupational disease or fatal work-related injury. The International Labour Organization (ILO) estimates that more than 2.3 million deaths occur annually from work- related causes.
313 million incidents occur each year that result in serious and disabling injuries and an economic burden of 4% on global gross domestic product (ILO, n.d.).
4,700 American workers suffer fatal traumatic injuries on the job each year, and employers record more than 3 million serious occupational injuries annually on the injury and illness logs they are required by law to maintain (BLS, 2014a, 2015).
Work Injuries and Illnesses Impose Heavy Costs on Workers, Families, and the Economy
The National Safety Council, for example, estimates that fatal and nonfatal work injuries in the United States cost more than $200 billion in 2013 (National Safety Council, 2015).
It is now widely recognized that the governments estimates of work- related injuries substantially understate the incidence of workplace injuries, probably by between 40% and 70% (Spieler & Wagner, 2014).
In part because of this latency, most illnesses with an occupational cause or contribution are not recognized as work related. However, several studies have estimated that approximately 50,000 annual U.S. deaths are attributable to past workplace exposure to hazardous agents such as asbestos, silica, and benzene, with another 400,000 workers suffering nonfatal illnesses from such exposures
5
Rana plaza factory incident
The workplace hazards that cause or contribute to injuries and illnesses differ depending on the industry and nature of the work.
Garment and textile industry workers, for example, may be exposed to cotton dust, which can cause lung disease, and repetitive motion hazards, which can lead to carpal tunnel syndrome and other musculoskeletal disorders (MSDs).
The 2013 Rana Plaza factory collapse in Bangladesh, which killed more than 1,100 mostly women workers, was a harsh reminder that many people work in dangerous structures with building code violations.
Work Injuries and Illnesses Impose Heavy Costs on Workers, Families, and the Economy
About 250,000 workers in the United States are employed in poultry processing plants, facing production line speeds up to 140 birds per minute.
They frequently suffer disabling musculoskeletal injuries from forceful, repetitive movements; respiratory symptoms from disinfecting agents and organic dusts; and also lacerations and skin infections.
More than 500,000 workers employed in health care and social assistance jobs are injured each year, the largest number in any industry. The likelihood of a hospital worker being injured on the job is higher than that for a worker in construction or manufacturing.
Ergonomic hazards; they are characterized by physical activities that require combining repetitive and/or forceful motions with awkward postures and positions.
Work Injuries and Illnesses Impose Heavy Costs on Workers, Families, and the Economy
When scientists from the National Institute for Occupational Safety and Health (NIOSH) surveyed workers employed in a large poultry processing plant in South Carolina, they found that more than 40% of workers had evidence of carpal tunnel syndrome, an MSD associated with repetitive, forceful hand activities (such as cutting up chicken).
Low and stagnant wages have forced some wage earners, especially those supporting a family, to hold two or more jobs.
In 18th-century England, Percival Pott (1715-1788) Recognized soot as one of the causes of scrotal Cancer among chimney sweeps. Advocated for passage of Chimney Sweeper Act of
1788- which finally provided protection to the chimney sweeps.
The fate of these people seems singularly hard, in the early infancy, they are most frequently treated
With great brutality, and almost starved in cold and Hunger; they are thrust up narrow, and sometimes hot Chimneys, they are bruised and burned, and almost
suffocated; and when they get to puberty, become Peculiarly liable to most noisome, painful and fatal
Disease. Percival Pott (1715-1788) and Chimney Sweepers Cancer of the Scrotum.
History of Occupational Health
Occupational health dates to Hippocrates and Pliny the Elder. Hippocrates recognized and recorded lead toxicity in the mining industry in the fourth century BCE.
Pliny the Elder, a Roman scholar of the first century BCE , described hazards associated with handling zinc and sulfur, first recorded industrial hygiene protective device, a mask constructed from an animal bladder that was used by miners and smelter workers exposed to dust or fumes.
Ulrich Ellenbog, in 1943 undertook formal study of occupational disease by publishing a pamphlet on occupational disease and injuries among gold miners, and wrote about the toxic effects of carbon monoxide, mercury, lead, and nitric acid.
In 1556, the Saxon physician and geologist Georgius Agricola described injuries and illnesses among miners, including Silicosis.
In 1700, Bernardino Ramazzini, regarded father of industrial hygiene published the first comprehensive book on industrial medicine. He asserted that occupational disease should be studied in work environment rather than hospitals.
History of Occupational Health
In 18th-century England, Percival Pott (1715-1788) recognized soot as one of the causes of scrotal cancer among chimney sweeps. Advocated for passage of Chimney Sweeper Act of 1788- which finally provided protection to the chimney sweeps.
Charles Turner Thackra (1795-1833) observed disease among the poor living in city of Leeds and made suggestions to improve public health. Led to the passage of the Factory Act (1833) and Mines Act (1842).
In the U.S. Alice Hamilton (1869-1970) was the first advocate of occupational health, and reformed factories, mines, etc. She startled the factory managers and state officials in Chicago with evidence of links between illness and industrial toxins. Was appointed director of states Occupational disease Commission and became first female professor at Harvard Medical School,- conducted industrial research.
The latter half of the twentieth century saw the development of modern academic departments of occupational health. One of the most prominent was led by Irving Selikoff at the Mount Sinai School of Medicine. He conducted one of the first studies linking asbestos to cancer- led international effort to reduce asbestos exposure.
Entry of the United States into the First World War in 1917 created a huge demand for a wide variety of radium treated devices and the workers to manufacture them. Large numbers of young women were employed as dial painters, and they applied radium paint with a fine-tipped brush. Because workers were paid on a piecework basis, it was common to tip or point brushes with the tongue to facilitate application of the paint. Over time, this practice could result in substantial absorption of radium. It became apparent during the 1920s that many dial painters were dying prematurely and were suffering from a variety of acute and chronic diseases. Particularly frightening was the frequency of disfiguring cancers and osteomyelitis of the upper and lower jaw.
– Deadly Glow: the Radium Dial Worker Tragedy.
Acute Injuries
Numerous injuries occur on the job each year; Injury rates are
highest in transportation, construction, and manufacturing.
Fatality rates in the workplace, however, are highest in
agriculture, mining, and transportation.
The rate of fatal work injury for U.S. workers in 2013 was 3.2 per 100,000 full-time equivalent (FTE) workers, compared to a final rate of 3.4 per 100,000 in 2012 (BLS, 2013).
Fatal work injuries among Hispanic or Latino workers were higher in 2013, rising 7 percent. The 797 Hispanic or Latino worker deaths in 2013 constituted the highest total since 2008. Fatal work injuries were lower among all other major racial/ ethnic groups (BLS, 2013).
Vulnerable workers
Vulnerable workers are likely to work in high-hazard occupations, have a higher probability of being first-generation immigrants, and are unlikely to be represented by a union.
Historically, many of the most dangerous jobs in the United States have been held by immigrants or by African Americans. For example, studies have shown that throughout the twentieth century, African American workers employed on coke ovens and in tire manufacturing plants were assigned to the jobs with the highest levels of exposure to toxic substances and, as a result, were at greatly increased risk of developing cancer.
According to BLS data, the overall fatality rate in 2013 for U.S. construction workers was 8.6 deaths per 100,000 workers, but for Latino construction workers the rate was 9.8 (Byler, 2013).
Vulnerable workers
In the 1960s, half of the jobs were in manufacturing and goods- producing industries. Today, 70% of jobs are in the service sector, from hospitality and retail to delivery drivers and home care aides.
Working in different settings with frequent changes makes it difficult to recognize and respond to worksite- specific hazards.
Warning signs and work instructions may not be provided in a language spoken by the worker. These workers may also be unaware of the protections that are supposed to be provided on the job, and be worried that identifying problems may result in job loss.
Vulnerable workers
Workplace policies cover such diverse health-relevant areas as availability of paid sick leave; the amount of advance notice a worker gets when a working shift is cancelled, extended, or otherwise changed; whether the employer can mandate overtime shifts; the availability of protective clothing, a place to change, and toilet facilities; how workers are disciplined for rule infractions; and so forth.
All of these policies can have a profound impact on a workers sleep patterns, availability to deal with family responsibilities and emergencies, and overall health and well-being.
While any type of work can be the source of stress, studies have shown that high-stress jobs may not have a deleterious impact on individual workers if they can adequately control their environments and the demands put on them. In other words, the assembly-line job in which the worker cannot control the speed of the environment will have a more consequential effect on the worker than the stress faced by the chief executive.
Health care facilities: occupational safety and health challenges and opportunities
Across the country, nursing aides, orderlies, and attendants have an incidence rate of musculoskeletal injuries more than seven times the average for all industries, and it is increasing.
There is a clear link between patient safety and worker safety in hospitals. If nursing aides are unable to lift patients without endangering their backs and if emergency room personnel are fearful of being assaulted, the quality of their patient care suffer.
Along with chronic pain and loss of function, absenteeism, and turnover among workers, health care worker injuries also result in higher employer costs due to medical expenses, disability compensation, and litigation.
As many as 20% of nurses leave direct patient care positions because of risks associated with their work.
Child workers
In the US, child labor laws are in place that are intended to recognize the inherent vulnerabilities that youths face, including an increased risk that they will be exploited in the workplace.
However, the lack of comprehensive regulatory enforcement and the widescale lack of information among child workers, parents, and employers about child worker rights and protections contribute to the thousands of preventable work-related injuries and illnesses among youths each year.
An estimated 150 million children world wide are involved in child labor- UNICEF
In the worlds poorest countries, nearly one in four children are engaged in work that is potentially harmful to their health- UNICEF
Child labor Globally-ILO
Worldwide 218 million children between 5 and 17 years are in employment. Among them, 152 million are victims of child labour; almost half of them, 73 million, work in hazardous child labour.
In absolute terms, almost half of child labour (72.1 million) is to be found in Africa; 62.1 million in the Asia and the Pacific; 10.7 million in the Americas; 1.2 million in the Arab States and 5.5 million in Europe and Central Asia.
In terms of prevalence, 1 in 5 children in Africa (19.6%) are in child labour, whilst prevalence in other regions is between 3% and 7%: 2.9% in the Arab States (1 in 35 children); 4.1% in Europe and Central Asia (1 in 25); 5.3% in the Americas (1 in 19) and 7.4%in Asia and the Pacific region (1 in 14).
Child labour is concentrated primarily in agriculture (71%), which includes fishing, forestry, livestock herding and aquaculture, and comprises both subsistence and commercial farming; 17%in Services; and 12% in the Industrial sector, including mining.
Protecting the health and safety on job
In the late nineteenth and early twentieth centuries, immigrant workers built the railroads and produced the steel needed for Americas rapid industrial development. It is no exaggeration to say that the nations evolution as an industrial power was marked by carnage in the workplace.
An early survey of workplace fatalities in the United States took place in Allegheny County, Pennsylvania, from July 1906 through
June 1907. The results are represented on a gruesome Death Calendar (see Figure 21.1). In that county alone, 526 workers died in work accidents during that twelve-month period, and 195 of them were steelworkersa steelworker death on the job roughly every two days ((Eastman, 1910).
In 1913 the Bureau of Labor Statistics estimated 23,000 industrial deaths in a workforce of 38 million, equivalent to a rate of 61 deaths per 100,000 workers, almost twenty times the current rate. (Centers for Disease Control and Prevention, 1999).
Protecting the health and safety on job
Dr. Alice Hamilton, who later was the first woman appointed to the faculty of the Harvard Medical School, lived in working-class, immigrant neighborhoods and investigated the impact of the residents harsh working conditions on their health.
Her survey in 1910 of occupational illness in the State of Illinois led to one of the first laws requiring employers to implement certain safety practices.
Protecting the health and safety on job
On March 25, 1911, fire broke out on the top floors of the factory building near Greenwich Village, in lower Manhattan. The mostly young women employed in the sweatshop operated by the Triangle Shirtwaist Company saw the smoke and heard the cries from floors below and tried to flee the building, but the exit doors had been locked by their employer to prevent theft. Sprinklers and other fire preven- tion devices had never been installed in this ten-year-old building; they were available at the time, but there was no law requiring them in private workplaces.
Hundreds gathered outside the building to watch the tragedy unfold. The onlookers saw that the firefighters ladders were too short and water from the hoses could not reach the top floors. And they watched as dozens of women and girls jumped to their deaths, more than 100 feet to the street below, to avoid the flames. A total of 146 workers, mostly Italian and Jewish immigrants and their children, were killed.
The social and political impact of this tragedy was enormous. Clothing workers unions led the protests, and their membership grew enormously following the fire. Over the next several decades these unions were able to achieve significant economic gains for previously low-paid garment workers, and bring stability to a ferociously competitive industry.
One of the witnesses to the fire was a young social worker named Francis Perkins, who was having tea with a friend in nearby Greenwich Village when the fire broke out.
Protecting the health and safety on job
In 1933, President Franklin Roosevelt appointed her to the position of Secretary of Labor, the nations first female cabinet member. She was the longest serving secretary in the history of the Labor Department, and she was instrumental in the enactment of many of the nations most important worker protections, including pensions for older Americans, unemployment benefits, and minimum wage and overtime laws.
Several thousand workers, mainly African Americans, were hired to dig a tunnel for a hydroelectric project in Gauley Bridge, West Virginia.
When it was discovered that the mountain through which they dug was more than 90% pure silica, the excavation was expanded to extract more of this industrial-grade material. Men started dying of silicosis within months after exposure began. Hundreds if not thousands died and many of the survivors were disabled for life.
Governments role in protecting workers
Environmentalists and labor unions forced public attention on unsafe air, water, and workplaces. Coal miners picketed on Capitol Hill to demand protections from black lung disease.
Labor union members who worked in chemical plants, automobile factories, and steel mills insisted that lawmakers address high rates of cancer and other ailments in their ranks.
Congress responded to several coal mine disasters, as well as massive protests over the failure of the workers compensation systems in West Virginia, Kentucky, and other coal mining states, by passing the Federal Coal Mine Health and Safety Act of 1969, generally referred to as the Coal Act (also see Text Box 21.2).
The following year, Congress passed the Occupational Safety and Health Act (OSH Act) of 1970, creating the Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH), and, for the first time, establishing as national policy the right of workers to a safe workplace.
Governments role in protecting workers
Under the OSH Act, OSHA, located in the U.S. Department of Labor, is the primary government agency.
Charged with ensuring that employers meet the requirements of the law. One notable aspect of the law is that it provides states with the option of implementing their own OSHA programs, as long as they are at least as effective as the federal OSHA regulations.
In all, twenty-one states have chosen to operate state OSHA programs covering both private and public sector workers, leaving the federal OSHA with responsibility in twenty-nine states and the District of Columbia.
Governments role in protecting workers
Mine Safety and Health Administration (MSHA), also part of the U.S. Department of Labor.
The U.S. Department of the Interiors Bureau of Safety and Environmental Enforcement provides safety and health coverage for workers drilling for oil or gas three or more miles beyond the shore, and various agencies in the U.S. Department of Transportation cover safety and health for truck drivers and some workers involved with railroads, air transportation, and pipelines.
Together, federal and state OSHA programs employ approximately 2200 inspectors, to safeguard roughly 130 million workers employed in between 7 million and 8 million workplacesnearly 60,000 workers, and 3,600 workplaces, per inspector. In all, OSHA inspectors visit fewer than 100,000 workplaces a year. The relative size of the safety and health inspectorate has changed dramatically over time. In the late 1970s, there were about fifteen federal compliance officers for every million covered workers. Currently, there are roughly seven inspectors for every million covered workers (AFL-CIO, 2015).
Governments role in protecting workers
NIOSH, located within the U.S. Department of Health and Human Services, is the third federal agency with a primary focus on occupational health and safety. NIOSH is responsible for conducting research and applying research resultsits own and those of other investigatorsin order to make science-based recommendations for reducing occupational disease, injury, and deaths.
NIOSH supports the training of health and safety professionals and scientific research, as well as the dissemination of information to those in a position to improve worker health, safety, and well- being.
Control of chemical hazards
With few exceptions, workers are the group with the highest exposures to chemical substances. In those workplaces where chemicals are produced or used, exposure levels are often many times higher than are found in the general environment.
With few exceptions, workers are the group with the highest exposures to chemical substances. In those workplaces where chemicals are produced or used, exposure levels are often many times higher than are found in the general environment.
The EPA also has specific mandates and authority to protect the most vulnerable the very young and chronically illfrom airborne toxics. OSHA and MSHA standards are intended to protect people who are healthy enough to work, even if they are exposed throughout their working lifetime.
While the goals of both the EPA and the worker protection agencies are often unmet, the EPAs standards are far stricter than those of OSHA and MSHA for the same substance.
Control of chemical hazards
OSHA has been successful in limiting exposure to some of the best-known and most dangerous workplace chemicals, chemicals that were virtually unregulated before OSHA. For example, asbestos was widely present in commercial construction, shipyards, and the manufacture of certain friction products like brakes.
OSHA has been successful in limiting exposure to some of the best-known and most dangerous workplace chemicals, chemicals that were virtually unregulated before OSHA. For example, asbestos was widely present in commercial construction, shipyards, and the manufacture of certain friction products like brakes.
OSHA tightly regulates current use, and few workers remain exposed to the substance. However, OSHAs standards regulating workplace exposure to chemicals are for the most part out of date and inadequately protective.
Osha inspections and penalties
With its limited number of inspectors, OSHA will generally visit a worksite for one of the following reasons: because of a worker complaint, a fatality, or a serious injury or because the site is in a high-hazard industry and therefore subject to random visits.
In theory, the threat of a monetary penalty encourages employers to comply with OSHAs requirements.
As of December 2015, the maximum penalties were $7,000 for a serious violation and $70,000 for a repeat or willful violation.
In 1970, an estimated 14,000 workers were killed on the job, an annual rate of 18 per 100,000, or about 38 workers killed on the job every day. Today, with a far larger workforce, that rate has fallen to 3.3 per 100,000, or about 13 every day
Workers compensation system limitation
The workers compensation system was originally designed so that employer- provided insurance would reimburse workers for lost wages while providing medical coverage and rehabilitation associated with work-related injuries.
Injured workers, however, face numerous barriers to filing and receiving compensation for their injuries (Azaroff, Levenstein, & Wegman, 2002), and only a fraction of injured workers receive any benefits through the state workers compensation programs (Shannon & Loew, 2012).
For example, in an enumeration of all recordable work-related amputations in Massachusetts, less than 50% of the cases received any workers compensation benefits (Davis et al., 2014).
Workers compensation system performs even more poorly for low-wage workers. Many injured low-wage workers face additional barriers to filing, including greater job insecurity, lack of knowledge about their rights, or a limited command of English. In particular, immigrant workers may fear wrongful termination or retaliation for filing or even reporting an injury.
Workers compensation system limitation
Most cases of work-related chronic disease are rarely diagnosed as work related. When that linkage is made.
The diagnosis generally comes long after employment ends. Even when the proper diagnosis is made, a worker who is eligible for benefits under Medicare, Medicaid, the Veterans Health Administration, or a private insurer is more likely to take that route, and avoid the challenges of obtaining benefits through the workers compensation system (Leigh, 2011; Leigh & Robbins, 2004).
Who pays for work related injuries and illnesses?
In the United States currently, costs of workplace injury and illness are borne primarily by injured workers, their families, and taxpayer- supported safety net programs.
Workers compensation payments cover only about 21% of lost wages and medical costs due to work injuries and illnesses, and private health insurance handles only 13%. Workers and their families pay for 50% of these costs, with taxpayers shouldering the remaining 16% (Leigh & Marcin, Source: Leigh & Marcin, 2012. 2012) (also see Figure 21.2).
A recent study of the impact on earnings, for instance, found that workers in New Mexico who receive workers compensation benefits for wage loss caused by workplace injuries lose an average of 15% of predicted earnings over the ten years following the injury. Even with workers compensation benefits, an injured workers income is, on average, almost $36,000 less over ten years than if the injury had not occurred (Scherer, Seabury, OLeary, & Ozonoff, 2014).
Sustainability
a shift to sustainabilityfor example, to renewable energy and recycled or green productsdoes not necessarily guarantee improved workplace health and safety. For example, workers involved with wind turbines are at high risk of injury from falls and welding arc flashes.
New techniques developed to construct green buildings, such as skylights and wastewater recovery, have resulted in worker fatalities. Workers at recycling facilities are exposed to arsenic, cadmium, other heavy metals, and organic dusts, as well as fire hazards and the risk of injury from repetitive motion.
Worker safety is also becoming a component of various measures of sustainability, especially as investors are looking to invest in sustainable firms. This investor interest in worker safety stems from the growing recognition that well-managed firms are safe firms, and that high injury rates are signs of a poorly managed firms
Sustainability
The close relationship between safety and sustainable management can be seen in the transformation of the aluminum producer Alcoa under the leadership of CEO Paul ONeil.
When ONeil (who was later appointed Secretary of the Treasury by President George W. Bush) became CEO of Alcoa, he focused the entire corporation on the goal of zero injuries. As the company took tight control of production processes to drive down injury rates, Alcoa workers were able to produce higher quality products in a more efficient manner.
Under ONeils leadership, Alcoas net annual income increased fivefold, and its market capitalization grew by $27 billion. At the same time, the injury rate among Alcoa workers dropped.
globalization
As a result of our drive toward globalization, work and its hazards no longer respect national boundaries.
Many goods are assembled in one country from parts manufactured in multiple other places, and then the finished goods are distributed both nationally and internationally.
Occasionally a large multinational employer takes responsibility for ensuring the health and safety of workers all along these complex supply chains, but more often hazards are confronted and addressed (or ignored) at the local level.
Many low- and middle-income countries have limited means to ensure workforce protections. Many countries rely in whole or in part on standards or conventions developed by international organizations such as the International Labour Organization, a United Nations agency.
globalization
The ILO and WHO have worked together to provide the technical support and training that enables countries to develop and implement these programs. Both organizations have focused on reducing or eliminating the use of asbestos as well.
They have also highlighted the plight of the most vulnerable workers, particularly children.
National and international nongovernmental organizations, including labor unions and human rights organizations, actively promote worker protections.
globalization
In some instances, international pressure has led to improvements in working conditions in developing countries.
For example, a series of catastrophic events in Bangladesh, culminating with the death of more than 1,100 workers in the 2013 Rana Plaza factory collapse, triggered international outrage at some of the well-known U.S. and European clothing brands that had contracted for the work being performed in those unsafe factories.
In response, some Western clothing brands have formed organizations whose aim is to help identify and eliminate the most significant hazards in Bangladesh clothing factories. While it appears that these programs have had some impact on conditions in this one countrys clothing factories, the success of any program that aims at a single country will be limited.
This limitation stems from the propensity of industries will move to locations where costs, including worker wages and safety requirements, are lower.
globalization
This raises important questions for citizens of all countries, but especially the developed ones: What is our responsibility to the worker in a developing country or an emerging industrial power, laboring in unsafe conditions to produce consumer products for Europe or the United States?
If we believe that all workers should be able to come home safely to their families at the end of their shifts, then worker safety and health is more than a labor issue or a factor in an economics discussion; it is an issue of global human rights.
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