In the 18th session in the second series of assessments of
Healthy People 2010, Acting Assistant Secretary for Health Donald
Wright chaired a Progress Review on Occupational Safety and Health. He was
assisted by staff of the lead agency for this Healthy People 2010
focus area, the Centers for Disease Control and Prevention (CDC) National
Institute for Occupational Safety and Health (NIOSH). Also participating in the
review were representatives from other offices and agencies within the U.S.
Department of Health and Human Services (HHS) and the U.S. Department of Labor
(DOL), including representatives from the Bureau of Labor Statistics (BLS) and
the Occupational Safety and Health Administration (OSHA). Dr. Wright, who was
formerly the Director of the Office of Occupational Medicine at OSHA, observed
that occupational safety and health is an area in which the Nation has made
great gains. Injury and death rates have fallen sharply in the period since the
founding of OSHA and NIOSH in 1970. During that time the number of workers in
the United States has doubled. Still, even with consistent progress, a great
deal remains to be done.
The complete November 2000 text for the Occupational Safety
and Health focus area of Healthy People 2010 is available online at
www.healthypeople.gov/document/html/volume2/20occsh.htm.
Revisions to the focus area chapter that were made after the January 2005
Midcourse Review are available at www.healthypeople.gov/data/midcourse/html/focusareas/fa20toc.htm.
Additional data used in the Progress Review for this focus area's objectives
and their detailed definitions can be accessed at wonder.cdc.gov/data2010. For
comparison with the current state of the focus area, the report on the
first-round Progress Review (held on February 18, 2004) is archived at
www.healthypeople.gov/data/2010prog/focus20/2004fa20.htm.
The meeting agenda, tabulated data for all focus area objectives, charts, and
other materials used in the Progress Review can be found at a companion site
maintained by the CDC National Center for Health Statistics (NCHS): www.cdc.gov/nchs/about/otheract/hpdata2010/focusareas/fa20-osh2.htm.
Data Trends
In his overview of data for the focus area, NCHS Director
Edward Sondik outlined the annual burden of occupation-related injuries,
illness, and death in the United States. In 2006, 5,703 deaths related to work
were reported (about 16 per day), representing a significant decline since
1996, when 6,112 were reported. However, the trends in certain industries,
namely, mining and agriculture, do not align with the overall decline.
Similarly, although the number of cases of pneumoconiosis (e.g., black lung,
asbestosis, silicosis) has declined in many areas of the country, in other
areas cases are actually increasing. Additionally, more than 4 million new
cases of nonfatal injury or illness occurred in 2006. The estimated yearly cost
of occupational injuries and illnesses is $128 to $150 billion dollars.
Dr. Sondik noted that this focus area could serve
Healthy People 2010 as a model of success in progress toward attaining
the targets of its objectives. Of the 22 objectives and subobjectives in the
focus area that were continued after the Midcourse Review of Healthy People
2010, 6 have met or exceeded their targets, 11 are improving, 3 are getting
worse, 1 has no tracking data available, and 1 remains in developmental status.
Dr. Sondik then examined in greater detail the focus area objectives
highlighted in the Progress Review.
(Objs. 20-1a, -1b, -1c, -1d, -1e): The rate
of occupational fatalities decreased from 4.5 per 100,000 workers aged 16 and
older in 1998 to 3.9 per 100,000 in 2006. The 2010 target is 3.2 per 100,000
for all population groups. The rate per 100,000 for males in 2006 was 6.7,
compared with 0.6 for females. Overall industry rates have improved in recent
years for all population groups for whom data were available, except for black
non-Hispanics, whose occupational fatality rate increased slightly from 3.8 per
100,000 workers in 2000 to 3.9 per 100,000 in 2006. In 2006, injury death rates
per 100,000 workers aged 16 and older for particular classes of industry were
as follows: mining, 27.8an increase from 23.6 in 1998 (target, 16.5);
construction, 10.8a decrease from 14.5 in 1998 (target, 10.1);
transportation, 16.3an increase from 11.8 in 1998 (target, 8.3); and
agriculture, forestry, and fishing, 29.6an increase from 23.3 in 1998
(target, 16.3).
(Objs. 20-2a, -2b, -2c, -2d, -2e, -2f, -2g,
-2h): The rates of work-related injuries resulting in medical
treatment, lost time from work, or restricted work activity generally improved
overall and for particular classes of industry. In 2006, the overall rate was
4.2 per 100 full-time workers, the lowest rate since the BLS began the survey
in 1972. This surpasses the target of 4.3 per 100. Injury rates in 2006 per 100
full-time workers for particular classes of industry were as follows:
construction, 5.8-a decrease from 8.7 in 1998 that surpasses the target of 6.1;
health services, 5.4a decrease from 7.9 in 1998 that surpasses the target
of 5.5; agriculture, forestry, and fishing, 5.6a decrease from 7.6 in
1998 (target, 5.3); transportation, 6.3a decrease from 7.9 in 1998
(target, 5.5); mining, 3.4a decrease from 4.7 in 1998 (target, 3.3); and
manufacturing, 5.5a decrease from 8.5 in 1998 that surpasses the target
of 6.0. The work-related injury rate per 100 full-time adolescent workers aged
15 to 17 years was 4.4 in 2005, a decrease from 4.9 in 1998. The target is 3.5
per 100.
(Obj. 20-3): Injury and illness involving
days away from work due to overexertion or repetitive motion are down from a
rate of 675 per 100,000 full-time workers in 1997 to 349 per 100,000 in 2006.
The target is 338 per 100,000.
(Obj. 20-4): The number of deaths from
pneumoconiosis among people aged 15 years and older decreased from 2,928 in
1997 to 2,531 in 2004, marking significant progress toward the target of 1,900.
The exception to the downward trend is deaths from asbestosis, the number of
which has increased. These are long-term trends, as pneumoconiosis diseases are
typically chronic, and much time may elapse from initial exposure, to
diagnosis, to death.
(Obj. 20-7): The target of zero cases of
elevated blood lead concentrations equal to or greater than 25 µg/dL per
100,000 workers will likely not be reached by 2010. However, the rate is down,
from 12.1 in 1998 to 7.4 in 2005.
(Obj. 20-8): The rate of occupational skin
diseases or disorders declined from 67 new cases per 100,000 full-time workers
in 1997 to 45 new cases per 100,000 in 2002, surpassing the target of 47.
Key Challenges and Current Strategies
Representatives from NIOSH presented on principal themes of
the focus area: Christine Branche, Principal Associate Director; Steven Sauter,
Senior Scientist, Division of Applied Research and Technology; James Grosch,
Research Psychologist, Division of Applied Research and Technology; Mark
Stephenson, Senior Research Audiologist, Division of Applied Research and
Technology; and Lewis Wade, Senior Science Advisor. Their statements and
Progress Review briefing materials identified a number of barriers to achieving
the objectives, as well as activities under way to meet these challenges,
including the following.
Barriers
-
It is difficult for the public to understand the scale
and impact of occupational injuries and illness. Also, there is a widespread
and incorrect belief that certain preventable conditions are an acceptable risk
of employment.
-
Despite the progress of occupational research, including
the establishment of the National Occupational Research Agenda (NORA I and NORA
II) and the Research to Practice (r2p) initiative, gaps in scientific knowledge
regarding occupational health remain.
-
Disparities in occupational health are growing. The
number of Hispanic worker deaths in 2006 (937) is nearly double that in 1992
(532). The number of Hispanic workers is increasing, and Hispanic workers tend
to be employed in riskier occupations, such as construction, agriculture, and
manufacturing.
-
The U.S. workforce is agingthe greatest growth in
number of workers is currently in the 50 years and older age groupand the
potential effects cut across various categories of work. Older workers do not
recover as well from injury and, typically, remain away from work longer. The
trend in fatal workplace injuries has increased dramatically for workers aged
65 and older. However, their risk for nonfatal injuries and illness has leveled
off.
-
In 2006, nonfatal occupational injuries numbered more
than 3.9 million cases. Nonfatal occupational injury rates are highest for
young workers and decrease with age. Inexperience and minimal training in
occupational safety and health likely contribute to their higher
rates.
-
The organization of work is changing. With the shifts in
types of jobs and sectors of employment in the United States, fewer workers
have full-time, dayshift, year-round positions. The great increase in recent
years in the use of contractors means that an increasing proportion of the
workforce is without health insurance coverage. More and more workers use
telework options. Still, the average number of annual hours worked by Americans
continues to be higher than that for workers in most other industrialized
countries.
-
Changes in work organization may be related to a general
increase in frequent mental distress among wage earners. Seven percent of
full-time workers experienced a major depressive event in 2007. On average,
workers experiencing high levels of stress will each cost their employers
around $600 annually in increased health care utilization.
-
Working at home continues on an upward trend, but
multiple studies on work settings show that the risks for stress and work
overload are higher among people who are at home. The number of children and
others in the household who are in need of care amplifies those risks.
-
Work-related hearing loss accounts for approximately 10
percent of nonfatal occupational illnessesand is likely underreported. It
is the most common occupational illness in the manufacturing sector and its
development is insidious, often taking 5 years to be noticed by the worker. The
hearing acuity of the average 25-year-old carpenter is like that of a healthy
50-year-old. Data reporting in this area began only recently.
-
The mining industry is one of the more challenging
sectorsit is growing for the first time since the 1970s, and its
workforce is aging. Also, new mines are deeper and can pose more health
risksfor example, methane gas and poor mine design. Recent mine disasters
at Sago (WV) and Crandall Canyon (UT) have focused more attention and
legislation on miner health and safety issues.
-
Chemicals and chemical products have been the leading
sources of occupational skin diseases or disorders involving days away from
work. Although fewer workers in manufacturing are now exposed to such
substances, there are emerging hazards, such as nanomaterials.
-
The rate of deaths from work-related homicides met its
Healthy People 2010 target of 0.4 per 100,000 workers in 2005. Even
with this decrease, an average of 10 workers die in the United States each week
as a result of workplace homicide.
Activities and Outcomes
-
NORA, a NIOSH program begun in 1996, provides a
framework to foster occupational safety and research. NORA I resulted in 21
research priorities and a national research agenda. NORA II initiated a
sector-based approach in 2006 to increase focus on individual industries and
connect more directly with workers, businesses, and other partners. The eight
sectors currently addressed by NORA are agriculture, forestry, and fishing;
construction; health care and social assistance; manufacturing; mining;
services; transportation, warehousing, and utilities; and wholesale retail and
trade.
-
The NIOSH r2p initiative systematically translates
research results into new technologies, products, and practices for the
workplace. Successes of r2p include development of a new personal dust monitor
for assessing coal miners' exposure to coal dust, production of a booklet on
engineering measures to prevent injures on commercial crab-fishing vessels, and
contribution of results from NIOSH firefighter fatality investigations to the
revision of National Fire Protection Association standards on personal alert
safety systems.
-
NIOSH was the first Federal Agency to develop and
implement an electronic injury surveillance system. By greatly increasing the
number of data elements that can be captured, such a system can provide a more
comprehensive and accurate picture of the situation at issue.
-
The WorkLife initiative, introduced by NIOSH in
response to Steps to a Healthier US, works to integrate approaches to
work and health through better workplace programs, policies, and practices. A
recent WorkLife symposium found that many promising health-related worksite
practices have been implemented, but many need to be rigorously evaluated.
-
NIOSH has worked with DOL to increase reporting on
hearing loss and is attempting to establish data points to better assess
trends.
-
The Fatality Assessment and Control Evaluation (FACE)
identifies work situations with high risks of fatal injury through onsite
fatality investigations. A current target of FACE investigations is the deaths
of Hispanic or immigrant workers. In 2006, NIOSH and its partners conducted 243
FACE investigations, 95 of which were completed, disseminated, and posted on
the Web at www.cdc.gov/niosh/face/.
-
By means of a new surveillance plan carried out under
NORA in partnership with the National Opinion Research Center, NIOSH can now
track how job characteristics are changing. Data show that net skill use by
U.S. workers has increased significantly since 1977.
-
Among its recent accomplishments aimed at improving
health and safety standards and practices in the mining industry, NIOSH has
fostered design guidelines for retreat mining, recommendations on refuge
alternatives, and an improved, self-contained self-rescuer.
-
To address workplace homicides and assaults, NIOSH has
developed the Workplace Violence Research and Prevention Initiative. This
program has enhanced the research program and its outreach. NIOSH also is
funding universities and new research grants to develop, evaluate, and adopt
interventions to reduce workplace violence.
-
The Adult Blood Lead Epidemiology and Surveillance
(ABLES) program has expanded to track and respond to cases of excessive lead
exposure in adults in 37 States. In addition, the NIOSH technology application
"Hand Wipe Method for Detecting Lead" has been licensed commercially and is
being marketed. This hand wipe can quickly and easily detect the presence of
lead on skin and surfaces and prompt workers to perform more thorough
handwashing. This method can reduce lead exposure for more than 10,000 workers
and 900,000 children in the United States.
Approaches for Consideration
Participants in the Progress Review made the following
suggestions for public health professionals and policymakers to consider as
steps to enable further progress toward achieving the objectives for
Occupational Safety and Health:
-
Raise public awareness of the national impact of
occupational illness, injury, and death and of the fact that, to a significant
extent, these are preventable.
-
Improve surveillance of populations at disproportionate
risk for occupational illness and injury and identify research methods,
intervention approaches, and dissemination tools to reach these
populations.
-
To enhance the safety and health of older workers,
improve surveillance and focus on at-risk workers and new interventions.
-
Give greater attention to assessing the effectiveness
of interventions, to determining whether illnesses are, in fact, work-related
(taking into account the contribution of nonwork factors), and to translating
research into practice.
-
Increase inclusion of occupational safety-related items
on OSHA logs to enhance the overall quality of data, particularly for hearing
loss.
-
Target public health efforts and resources more
effectively to work-related injury prevention programs, especially in industry
sectors in which risk is greatest.
-
Encourage industry to step up worker training in the
proper use of hearing protectors, which can be very effective when worn
correctly.
-
To reduce nonfatal occupational injuries and illness,
assist employers in developing, evaluating, and adopting effective practices to
protect employees from musculoskeletal disorders.
-
Promote increased efforts on the part of the mining
industry to train workers in advanced escape and rescue techniques.
-
Improve tracking of pneumoconiosis cases to explain and
address shifts in rates over geographic areas and increases in deaths from
asbestosis in particular.
-
Because the onset of symptoms of work-related illness
and injury may not be closely linked in time to exposure to workplace hazards,
take steps to ensure that all relevant applications for workers' compensation
are reported to employers and captured in OSHA logs.
-
Seek to develop multiple data sources to better capture
information about problem areas of the economy where the incidence of
occupational injury and illness are particularly high.
Contacts for information about Healthy
People 2010 focus area 20Occupational Safety and
Health:
|
[Signed June 3, 2008] Donald Wright, M.D.,
M.P.H. Principal Deputy Assistant Secretary for Health
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