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OCR for page 141
17. Occupational Safely and Health
For some of the nearly 104 million men and women
in our nation's work force, Living is hazardous to
your health. Working is even more hazardous to your
health. (#337) An estimated 10 million traumatic
injuries occur on the job each year. In addition,
about 400,000 workers become ill from exposure to
hazardous substances in the workplace, and some
100,000 die prematurely from this exposure."
Many of the 43 testifiers on occupational health
issues call for improved or stepped-up cooperative
efforts between public and private sectors to help
achieve the nation's occupational safety and health
objectives. Stronger regulatory measures and, equally
important, stronger and more consistent implementa-
tion of existing regulations are high on many wit-
nesses' agenda. The Occupational Safety and Health
Administration (OSHA), the Food and Drug Admini-
stration, and the Environmental Protection Agency,
along with numerous state agencies, are seen as the
governmental groups with the greatest responsibility
for improving occupational safety and health in the
next decade. However, many testifiers recognize that
these groups can be only as effective as their funding
allows.
A Detroit Department of Health spokesperson
identifies several trends that will have some impact on
the year 2000 objectives, Including continued cigarette
smoking, which greatly magnifies the effects of toxic
agents; excessive government regulatory programs that
have led to an inhibition of new technologies for
hazardous waste treatment; more women in the
workplace, which has led to the emerging importance
of possible mutagens and teratogens; and illegal
dumping of toxic wastes, which has led to an increase
in the probability of contact with toxic agents.
(#210J
Among the worker protection issues discussed were
toxic agent exposure, injury control, reproductive
effects (for both women and men), and noise reduc-
tion.
Human immunodeficiency virus (HIV) infections
and AIDS were identified as an important occupa-
tional health focus for the year 2000, especially for
health care workers and law enforcement officers. A
compelling case was made for directing some objec-
tives to the special plight of farm workers, including
migrant workers. Farmers tend to work alone and
Do not have a collective voicer to represent their
complaints to equipment manufacturers or to govern-
ment regulatory agencies. (#540) They are excluded
from many laws and regulations such as some state
workers' compensation laws. Other occupations
singled out for special attention were construction
workers, fire fighters, working children, and retired
workers who could benefit from improved notification
procedures regarding hazards inherent in their former
jobs.
The need for more research into both the cause
and the effects of occupationally related diseases, and
the need for better data collection and analysis, were
common themes throughout much of the testimony.
Testimony on occupational safety and health issues
covers two separate but interrelated issues: the pro-
tection of workers from injuries and illness attribut-
able to the workplace itself, and the workplace as a
site for health promotion and disease prevention
activities. This chapter deals primarily with the
former; the latter issue is dealt with in more detail in
Chapter 9.
The first section of this chapter examines the spe-
cial needs of particular groups of workers: agricul-
tural workers, health professionals, and so on. The
second section highlights some particular problems to
be addressed in workplace protection: toxic agents,
injury control, etc. The third section describes briefly
the testimony on the workplace as a site for health
promotion and disease prevention activities. The final
section deals with implementation issues, including
surveillance and manpower needs.
GROUPS WITH PARTICULAR NEEDS
Several witnesses addressed specific occupations at
high risk for particular problems, including agricul-
tural workers, health care workers, construction
workers, law enforcement officers, and fire fighters.
Others were concerned about those who have retired
from occupations that may have exposed them to risk
and about children who are employed.
Agricultural Workers
David Pratt of the New York Center for Agricultural
Medicine and Health, at Bassett Hospital in New
Occupational Safer and Health 141
OCR for page 142
York, reports that agriculture has become the most
dangerous occupation in the United States.
Individuals who work in agriculture are injured or
killed at a rate that is substantially higher than the
mean for all U.S. workers. Pratt sees a problem of
social equity here.
Why do these men and women not deserve the
same safe working conditions on the job as
other Americans? How can we allow those who
produce the food we eat to finance it by squan-
dering human capital? Why should they pay
with their lives for the right to work? (#540)
A number of testifiers, such as Mary Ellis of the
Iowa Department of Public Health, believe that the
1990 Objectives focused primarily on industrial
hazards and injury control with little attention to
farm-related injuries and hazards. (#569J In Colora-
do, rural areas have a higher occupational mortality
rate than do urban areas, according to William
Marine of the University of Colorado School of Medi-
cine; from 1982 to 1984, for example, 20 percent of
the work force employed in rural areas suffered 48
percent of the occupational injury deaths in the
state.2 (#382)
Chuck Stout, Director of the Colorado Migrant
Program in the Colorado Department of Health, is
particularly concerned about the conditions under
which migrant workers labor. He cites a lack of
access to potable water, toilets, and hand-washing
facilities as serious and common problems in such
settings. Although OSHA recently (under court
order) set standards of basic hygiene conditions for
agricultural workers, Stout charges that the agency has
not developed mechanisms for inspection, enforce-
ment, handling of complaints, or informing growers of
their new responsibilities. nAmerica's farm workers
still suffer from diseases that may be controlled very
easily by the application of the most basic sanitation
measures that have been taken for granted for de-
cades by the rest of this country's labor forces."
¢#710)
Paul Monahan of the Yakima Valley Farm
Workers Clinic in Washington State recommends the
identification and elimination of legislative and
regulatory policies that discriminate against farm
workers. Exclusionary features of many laws and
regulations, he says, "have an adverse impact on the
health of farm workers." For example, some 20 states
provide no protection for farm workers under their
workers' compensation laws, and another 15 states
142 Healthy People 2000: Citizens Chart the Course
protect only restricted categories of temporary
workers. Unemployment benefits also are limited for
workers on small farms, according to Monahan; in the
off season, medical care for these workers is often
inaccessible because of the cost. (~330J
Health Care Workers
The American Society of Hospital Pharmacists is
concerned with the frequent use of pytotoxic and
hazardous substances in health care settings, with a
concomitant potential for toxicity to pharmacists,
nurses, and other health care personnel. The society's
Director of Clinical Affairs, Marie Smith, says that
employees who come in contact with such materials
should be made more aware and should adhere more
strictly to procedures for the safe handling of these
substances. (#574J
William Wilkinson of the University of Washington
addresses the risk of HIV infection to health care
workers: needlestick injuries and handling blood or
blood products are the primary sources of HIV infec-
tion for health workers. Wilkinson calls for more
research to determine the level of risk and for more
education of workers about research findings. (#319)
Similarly, the American Association of Occupational
Health Nurses (AAOHN) points to hepatitis B as a
major infectious occupational health hazard in the
health care industry. They cite unpublished data from
the Centers for Disease Control (CDC) indicating that
each year 500-600 health care workers whose jobs
involve exposure to blood are hospitalized with acute
hepatitis B and that more than 200 deaths occur
among health workers from this cause. Use of the
universal barrier precautions recommended by the
CDC should greatly diminish the risk of infection
from blood-borne pathogens, including both hepatitis
B and the HIV virus. In addition, the AAOHN
indicates that significant numbers of at-risk health
workers do not take advantage of the available vac-
cine against hepatitis B. (#558)
Other Hazardous Occupations
Several occupations, including construction, law
enforcement, and fine fighting, require workers to
undertake tasks on a daily basis that are both physi-
cally and emotionally hazardous.
The Laborers' International Union of North
America (LIUNA) reports that construction workers
suffer significantly more injuries, fatalities, and
diseases than other workers. At the same time,
OCR for page 143
according to LIUNA, federal government efforts to
protect construction workers have been lagging. The
union believes that specific objectives should be
established to eliminate the differential in injury and
illness rates between these workers and others.
(#586) Some construction workers also have been
exposed to very high levels of lead. For example,
according to Harvey Collins of the California Depart-
mer~t of Health Services, well over 3,000 individuals
in that state are reported each year to have blood
lead levels higher than 40 milligrams per deciliter.
It is suggested that these workers be included in the
standards for general workplace exposure to lead.
(#783)
Fred Toler, Executive Director of the Texas Com-
mission on Law Enforcement Officer Standards and
Education, is concerned with the health of law
enforcement workers. People frequently view the
felon as the greatest threat to the law enforcement
officer's health and safety, when he or she actually is
much more likely to die from heart disease, stroke,
automobile accident, cancer, or suicide," he says. Law
enforcement officers are widely perceived as heavier
users of tobacco than many other professionals, and
Toler calls for research to determine the accuracy of
this perception and to identify approaches that would
reduce such use. Law officers often are less physically
fit than is good for their health, which makes them
more susceptible to stress-related illnesses that may
result in premature death or a reduced quality of life.
Toler recommends training for this group in coping
and stress reduction to help reduce the incidence of
suicide, in handling hazardous substances, and in
proper techniques for protecting themselves against
AIDS and other contagious diseases. (~297)
Fire fighters, too, face high-stress situations daily
and encounter work-related hazards such as heat
stress, threat of physical injury, and exposure to toxic
gases emitted from the combustion of synthetic
materials in fires. (#108)
Retired Workers
Rebecca Richards of the North Woods Health Careers
Consortium in Michigan notes that a number of the
1990 Objectives relate to identification, notification,
and follow-up of workers at risk "while employedn; she
suggests that this be extended to retirees as well.
(~183) Because retired workers may have been ex-
posed to materials capable of inducing diseases of
long latency, LIUNA also urges that retirees be
included in any programs of information and educa
tion about occupational risks. Prevention-oriented
health programs aimed at retirees, LIUNA notes, may
mitigate the adverse health effects attributable to
prior workplace exposures and help workers with
work-related disease to avoid further disability and
complications. (#586)
Working Children
The health and safety of children who work on family
farms, in family businesses, or in other parts of the
economy not covered by federal requirements for
occupational safety and health are also of concern to
LIUNN Child labor under the age of 14 is legally
prohibited in the United States and should be elimi-
nated in those segments of the economy where it still
exists. At a minimum, LIUNA suggests a goal to
eradicate job-related injuries and illnesses in children
under age 14, and states that there were hundreds of
such claims under workers' compensation in a recent
year. (#586J
WORKPLACE PROTECTION ISSUES
From among the many specific workplace protection
issues, most witnesses focused on exposure to toxic
agents. Some, however, did address injury control,
reproductive effects, and noise. Occupationally re-
lated dermatitis was also noted as among the most
commonly occurring illnesses in the workplace.
(#569)
Toxic Agent Exposure
Robert Spear of the University of California, Berkeley
submits that the greatest risks to health from
exposure to chemical agents occur in the workplace,
with rare exceptions involving accidental releases to
the general environment. Therefore, toxic agent con-
trol in the workplace should be emphasized. We
must face the fact that, whatever the toxic hazard, the
odds are very high that workers will or have experi-
enced it first, and it is only sensible to have a strong
preventive program focussed on the occupational envi-
ronment." (#275)
George Gaines, representing the Detroit Depart-
ment of Health, reports that toxic agents that produce
acute or chronic illness are not new to the workplace,
but the rapid growth of new technologies and new,
potentially toxic, substances has led to a situation in
which "what we do know continues to be far
outweighed by what we do not know concerning all of
Occupational Safely and Health 143
OCR for page 144
the effects produced by toxic agents." He further
notes that, although the specific effects of some
individual materials are known, very little information
is available about the synergistic effects of toxic agents
on workers. It has become clear, for example, that
smoking tends to magnitr the effects of other toxic
agents. Gaines recommends the increased use of
multiphasic health testing to aid in identifying
possible and multiple effects of toxic agents. (#210)
Employee right-to-know programs are vital in
instructing employees about the procedures for
handling a tone substance and the actions to take in
the event of accident with such a substance. (#210)
Bernard Turnock of the Illinois Department of Public
Health says that worker right-to-know legislation
should be extended to include on-thejob instruction
about occupational hazards. He feels that it is
unreasonable to expect a prospective employee to
research workplace hazards, and applicants believe
that asking too many questions may result in being
denied a job. (~215)
Lawrence Kenney, President of the Washington
State Labor Council, AFL-CIO, reports that millions
of workers are exposed to neurotoxic agents In the
workplace and that many die or are disabled as a
result of this exposure. (~345) Raymond Singer of
the Mount Sinai School of Medicine notes that the
effects of neuroto~city are subtle and when symptoms
caused by exposure to these agents appear, they may
be attributed to "normal aging. Few U.S. workers
are currently monitored for signs of neurotoxicity,
although most of those who work with toxic chemicals
are exposed to neurotoxic substances; if toxicity is
detected early, permanent brain and nerve damage can
be prevented, according to Singer. (#638J Kenney
believes that worker education is the most effective
means of reducing the rate of occupational disease
and injury. (~345)
Turnock suggests a revision of a 1990 objective to
reduce occupational lung diseases because "assessing
[achievement of] the objectives in 1990 might create
a false sense of security. The current objective calls
for no new cases of asbestosis, byssinosis, silicosis, and
coal worker's pneumoconiosis by 1990. Because of
the long latency period between exposure and devel-
opment of the disease, Turnock believes that many
cases would not be detectable by 1990. He suggests
that the deadline for assessing this objective should be
2010. (~215)
144 Healthy People 2000: Citizens Chart the Course
Injury Control
Jeanette Winfree, representing the American Physical
Therapy Association, suggests that ergonomically
designed jobs can prevent injuries. She reports,
however, that employers are often reluctant to rede-
sign tasks due to the cost, although Data are begin-
ning to reveal ergonomically-designed jobs do prevent
costly injuries and allow the worker a safe environ-
ment.n (#313)
Michael Jarrett, Commissioner of the South
Carolina Department of Health and Environmental
Control, comments that as the work force ages,
occupational injuries or days lost due to injury may
increase. He suggests that specific objectives about
occupational injuries to those over 50 may be
appropriate. (#108)
Many industries report that the greatest number of
work days lost are due to back complaints, according
to Marilyn Gossman and Jane Walter of the
American Physical Therapy Association. They suggest
that fitness programs could serve as a preventive mea-
sure against these injuries. (~248) Kenneth Kizer of
the California Department of Health Services reports
that carpal tunnel syndrome "is second only to back
injury as a cause of lost time from repetitive motion
injuriesH and suggests that model reporting systems
and an intervention system be expanded to 50 percent
of the counties in the country. (#591)
Reproductive Effects
Several witnesses addressed the occupational effects
on reproductive health. According to the Centers for
Disease Control, at least 50 chemicals widely used in
industry have been shown to impair reproductive
function in animals; these chemicals include heavy
metals such as lead and cadmium, glycol ethers,
organohalide pesticides, and organic solvents. Studies
have shown increased rates of spontaneous abortion
among laboratory and chemical workers and other
workers exposed to lead, ethylene oxide, and
anesthetic gases.3
Joan Berlin and others from the American Civil
Liberties Union Foundation suggest that occupational
exposures may account in part for the large propor-
tion of infertility, miscarriages, infant mortality, and
birth defects that are labeled as idiopathic or "cause
unknown." They underscore the importance of look
OCR for page 145
ing at reproductive effects in men as well as women.
"The practice of using selective data to ban one group
of employees, always women, from an occupational
hazard that is deleterious to the health of both sexes
creates only the illusion of workplace safe. (~617)
Noise Reduction
The American Occupational Medical Association
(AOMA) reports that many U.S. production workers
have been exposed to high levels of noise and, as a
result, have varying degrees of hearing impairment.
In the future, noisy industries such as steel mills,
machine shops, and foundries will make up a smaller
proportion of jobs in the country; because of this fact,
as well as improved technology, acoustic engineering,
and better enforcement of laws, a lower rate of
hearing loss from such causes is to be expected.
(~071)
THE WORKPLACE AS A SITE FOR HEALTH
PROMOTION AND DISEASE PREVENTION
ACTIVITIES
When programs are properly designed, says Leon
Warshaw of the New York Business Group on
Health, the workplace is a uniquely advantageous site
for health promotion; employers may undertake such
programs to improve employees' well-being, morale,
and work performance, as well as to minimize the
company's costs for health services. (~448J Jill
F-loberg of Olympia Physical Therapy Service is less
certain about the economic value of worksite preven-
tion programs. Although there are some data availa-
ble, follow-up studies of in-house programs are as yet
inconclusive in showing long-term decreases in health-
related time loss and injury costs." (#317J Pat
Joseph, a representative of the American Association
of Occupational Health Nurses, says that the degree
of voluntary participation in workplace health
promotion programs is often higher than in similar
community-based programs. According to Joseph, the
increased participation is due to employee con-
venience, the presumption that programs are of good
quality if they are sponsored by the employer, the
employees' viewing the programs as a benefit, and the
availability of social support for a desired change in
behavior. (#385) Any objectives requiring more oc-
cupational safety and health services from businesses
should also recognize that smaller businesses may
need "ready access" to resources in order to provide
the services, according to Dorothea Johnson of
AT&T. f#450) Workplace health promotion and
disease prevention are discussed in greater detail in
Chapter 9.
IMPLEMENTATION
The AOMA stresses the importance of a collaborative
effort between government and the private sector
toward reaching occupational health goals. This effort
should indude jointly designed and sponsored edllca-
tional programs, plant health and safety committees,
and jointly designed and operated employee assistance
programs. (#071) noberg, who represented the
American Physical Therapy Association, would like to
see the development of a labor-management relation-
ship that removes health and safety issues from the
politics of contract negotiation. (~317) Givens and
Floberg agree that, in general, rewards are more
effective than punitive measures. Thus, the AOMA
wants to see rewards that encourage win-win attitudes
between management and labor applied to the
development and implementation of environmental
hazard controls. (#071) Floberg specifically suggests
that financial incentives through insurance or tax
measures be used to reward companies and individuals
for successful prevention and promotion programs.
(#317J
Harvey Checkoway of the University of Washington
suggests that the primary targets for occupational
safen,r and health objectives be those diseases and
injuries that have unambiguous occupational etiologies
and are truly preventable. He urges concentration on
selecting objectives that can be met realistically;
developing methods for monitoring the occurrence of
occupational diseases and injuries; and developing
approaches for remediation of unacceptable risks.
Among the conditions or diseases that should be
monitored, he includes occupational asthma, lead
poisoning, silicosis, carpal tunnel syndrome, noise-
induced hearing loss, disabling injuries at the work-
site, asbestosis, byssinosis, coal workers' pneumo-
coniosis, occupational hepatitis, solvent-induced
encephalopathy, and peripheral nellropathy. (#245)
Surveillance
A number of people testified about the inadequacy of
statistics on occupational health, which LIUNA refers
to as "the failure to recognize the woeful inadequacy
of occupational injury and illness statistics." The
union cites a 1987 National Academy of Sciences
Occupational Safety and Health 145
OCR for page 146
report in support of its claim that the United States
does not have a timely, accurate assessment of mor-
bidity or mortality associated with job-related injuries,
occupational diseases, and work-related disorders.4
(#586)
Joseph suggests a standardized, ongoing occupation-
al health hazard injury and illness coding system.
(#385J Checkoway would establish regional centers
for disease surveillance and research, because
~workers' compensation claims, hospital discharge
summaries and death certificates vary in quality and
quantity of information" and "some of the important
adverse health events occur in small workplaces where
exposures often are not monitored and may be
excessive." With good regional centers, nationwide
monitoring is possible, and surveillance should then
be supplemented by specifically designed industrial
hygiene and safety remediation programs, he says.
f#245) Marine suggests a computerized linkage of
state workers' compensation data with state death
certificate files to provide a more complete count of
fatalities than either source alone. (~382) Ellis
recommends the expansion of statistical, surveillance,
and epidemiological studies related to farm injuries
and diseases. She also advocates the use of hospital
discharge data-including E-coding and information
about a patient's occupation and industry for occupa-
tional illness and injury surveillance. (#569) This
type of information tracking requires that health
workers take occupational histories and correctly
interpret their findings. Kizer cautions, "There is no
REFERENCES
easy way to determine whether health care providers
currently do this." (#591 J
Manpower
Kenney urges increased emphasis in medical schools
on the identification of occupational diseases. Many
workers' compensation claims go unfired each year, he
says, because neither the doctor nor the patient can
identify the cause of a particular condition. (~345)
Steven Levine of the University of Michigan also calls
for more training In occupational fields. He advo-
cates developing an adequate supply of qualified
personnel to carry out the purposes of the Occupa-
tional Safety and Health Act by maintaining and
expanding the Educational Resource Centers program,
which trains various occupational safety and health
specialists. (~392) Bernard Goldstein of the Uni-
versi~ of Medicine and Dentistry of New Jersey calls
for more trained public health professionals and
better geographic distribution and outreach of existing
graduate-training facilities in public health. (#625)
Wilkinson would like to see the number of occupa-
tional health professionals at industry sites increased
and suggests that occupational health nurses assume
the majority of these positions. (#319) The
AAOHN agrees that occupational health nurses are
well suited to be worksite health promotion pro-
fessionals and recommends that every state health
department hire at least one occupational health
nurse as a consultant to local industries. (#558)
1. U.S. Department of Health and Human Services: The 1990 Health Objectives for the Nation: A Midcourse
Review. Washington, D.C.: U.S. Government Printing Office, November 1986
2. Colorado Department of Health, Health Statistics Section: Colorado Population-based Occupational Injury
and Fatality Surveillance System Report, 1982-1984. Denver, n.d.
3. Centers for Disease Control: Leading work-related diseases and injuries-United States. Morbid Mortal Wkly
Rep 34~35~:537-540, 1985
4. Pollack ES, Keimig DG (Eds.~: Counting Injuries and Illnesses in the Workplace: Proposals for a Better
System. Washington D.C.: National Academy Press, 1987
TESTIFIERS CITED IN CHAPTER 17
071 Givens, Austin; American Occupational Medical Association
108 Jarrett, Michael; South Carolina Department of Health and Environmental Control
183 Richards, Rebecca; North Woods Health Careers Consortium (Wausau, Wisconsin)
146 Healthy People 2000: Citizens Chart the Course
OCR for page 147
210 Gaines, George; Detroit Department of Health
215 Turnock, Bernard; Illinois Department of Public Health
245 Checkoway, Haney; University of Washington
248 Gossman, Marilyn and Walter, Jane; American Physical Therapy Association
275 Spear, Robert; University of California, Berkeley
297 Toter, Fred; Texas Commission on Law Enforcement Officer Standards and Education
313 Winfree, Jeanette; Physical Therapy Services (Galveston, Texas)
317 Floberg, Jill; Olympia Physical Therapy Service
319 Wilkinson, William; University of Washington
330 Monahan, Paul; Yakima Valley Farm Workers Clinic (Toppenish, Washington)
337 Sugarman, Jute; Washington State Department of Social and Health Services
345 Kenney, Lawrence; Washington State Labor Council, AFL-CIO
382 Marine, William; University of Colorado Health Sciences Center
385 Joseph, Pat; United States Air Force, Lowly Air Force Base, Denver
392 Levine, Steven; University of Michigan
448 Warshaw, Leon; New York Business Group on Health
450 Johnson, Dorothea; AT&T
540 Pratt, David; MaIy Imogene Bassett Hospital (Cooperstown, New York)
558 Babbitz, Matilda; American Association of Occupational Health Nurses
569 Ellis, Mary; Iowa Department of Public Health
574 Smith, Marie; American Society of Hospital Pharmacists
586 Fosco, Angelo; Laborers' International Union of North America
591 Kizer, Kenneth; California Department of Health Services
617 Berlin, Joan and Taras, Ana; American Civil Liberties Union Foundation, and Stellman, Jeanne; Columbia
University
625 Goldstein, Bernard; University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical
School
638 Singer, Raymond; Mount Sinai School of Medicine
710 Stout, Chuck; Colorado Department of Health
783 Collins, Harvey; California Department of Health Services
Occupational Safety and Health 147
Representative terms from entire chapter:
occupational safety
