In the 18th in a series of assessments of Healthy
People 2010, Deputy Assistant Secretary for Health Howard
Zucker chaired a focus area Progress Review on Occupational Safety
and
Health. In underscoring the magnitude of risks to life and health
faced by workers in the United States, Dr. Zucker noted that an
estimated 11,000 workers were disabled each day by work-related
injuries in the 1990s and that, on average, 130 workers died daily
from work-related diseases. In conducting the review, Dr. Zucker
was assisted by staff of the lead agency for this Healthy People
2010 focus area, the National Institute for Occupational Safety
and Health (NIOSH), part of the Centers for Disease Control and
Prevention (CDC). Also participating were representatives of other
U.S. Department of Health and Human Services’ offices and
agencies. Joining them were officials of agencies within the Department
of Labor that carry out the Federal Government’s data reporting,
oversight, and regulatory functions for safeguarding the health
and safety of workers—the Bureau of Labor Statistics, the
Occupational Safety and Health Administration, and the Mine Safety
and Health Administration.
The complete text for the Occupational Safety and Health focus area of Healthy
People 2010 is available at www.healthypeople.gov/document/html/volume2/20occsh.htm.The
meeting agenda, tabulated data for all focus area objectives, charts, and other materials
used in the Progress Review can be found at www.cdc.gov/nchs/about/
otheract/hpdata2010/focusareas/fa20-osh.htm.
Data Trends
Edward Sondik, Director of CDC’s National Center for Health Statistics,
set the context for objectives in the Occupational Safety and Health focus
area, noting that 5,524 work-related injury deaths occurred in the United States
in 2002, or approximately 15 per day. More than 4.7 million new nonfatal injuries
and illnesses were reported in private industry alone in that year. The direct
costs of occupational injuries and illnesses are estimated at $45.8 billion,
and indirect costs may range up to $229 billion. Nonetheless, of the 11 objectives
in the focus area, the progress of 8 can be assessed, and all of these have
shown improvement in this decade. The 2010 target has been met for the reduction
of work-related homicides to 0.4 per 100,000 workers aged 16 years and older
(Obj. 20-5). The target for occupational skin diseases or disorders was 80
percent achieved as of February 2004 (Obj. 20-8—see below). Progress
also was shown in reducing work-related injuries resulting in medical treatment,
loss of time from work, or restricted work activity. In 2002, the incidence
of such injuries had been reduced 63 percent of the way to the target of 4.3
injuries per 100 full-time workers in private industry (Obj. 20-2).
Dr. Sondik focused on objectives that addressed the major topics highlighted
in the Progress Review. These topics included the challenge of eliminating
health disparities (illustrated using occupational injury deaths among young
workers and Hispanics), the challenge of improving workers' health and safety
in high-risk industries (illustrated using injury deaths and pneumoconiosis
in mining), and the notable success in reducing the burden of occupational
skin diseases or disorders. Between 1998 and 2002, the rate of work-related
injury deaths in all industries decreased from 4.5 to 4.0 per 100,000 workers
aged 16 years and older. The 2010 target is 3.2 per 100,000 (Obj. 20-1). By
industry, the highest rates of work-related injury deaths in 2002 were recorded
for mining and agriculture (>20 per 100,000), followed by construction and
transportation (>10 per 100,000). Of the total number of occupational injury
deaths (5,524), 43 percent occurred in connection with transportation-associated
activity. By gender, the rate of work-related injury deaths among males in
2002 was 6.9 per 100,000, compared with 0.7 per 100,000 among females, partly
due to the preponderance of male employees in the more hazardous occupations.
By ethnic or racial group, the highest rate of deaths from occupational injuries
recorded over the period 1995–2000 (5.0 per 100,000) was for Hispanics.
The greatest number of occupational injury deaths among Hispanic workers occurred
among those employed in the construction industry. In 2002, roughly two-thirds
of the Hispanics who died from work-related injuries were foreign born. Among
all workers younger than 18 years of age, 41 percent of work-related injury
deaths in the period 1992–2002 occurred among those employed in agriculture.
In the mining industry as a whole, the highest rate of work-related injury
deaths in 2002 was recorded for coal mining, followed by the mining of nonmetals
(other than coal), then by oil and gas extraction. In underground mining, 43.3
percent of work-related injury deaths in 1998–2002 were caused by cave-ins
(e.g., collapse of the mining face or overhead). In surface mining, the largest
proportion of deaths was caused by “powered haulage” (such as contact
with equipment and vehicles used to haul materials).
Over the past three decades, the prevalence of coal workers’ pneumoconiosis
has declined sharply, most dramatically among miners who have worked in the
industry for more than 25 years. In the period 1973–1978, 35 percent
of this cohort had coal workers’ pneumoconiosis, whereas in 1996–2002,
only 5 percent did. In 2000, the number of deaths from this disease was 950,
compared with 1,003 deaths in 1999. Coal workers’ pneumoconiosis accounted
for about one-half of the total deaths (4,963) from all forms of pneumoconiosis
in 1974, compared with about one-third of the total (2,864) in 2000. Deaths
from other pneumoconioses increased by more than one-third between 1983 and
2000, with asbestosis playing a large role in the rise. The 2010 target for
total number of pneumoconiosis deaths is 1,900 (Obj. 20-4).
In 2002, skin diseases or disorders accounted for
15.2 percent of nonfatal occupational illnesses, of which the total number
was approximately 294,500. The 2010 target for all occupational skin diseases
or disorders is 47 new cases per 100,000 full-time workers aged 16 years and
older (Obj. 20-8). The rate was 51 per 100,000 in 2002, a significant decline
from 67 cases per 100,000 workers in 1997. Dermatitis, the largest cause of
occupational skin diseases or disorders, declined from a rate of 1.2 cases
involving days away from work per 10,000 workers in 1992 to 0.5 cases per 10,000
workers in 2001.
Key Challenges
NIOSH and participants in the review identified a number of obstacles to achieving
the objectives, including the following:
- The mining environment poses a high degree of threat to the life and health
of workers. Approximately 90 percent of miners are hearing
impaired by age 50.
Fatalities in mining are decreasing, but even so, coal mining had a fatality
rate in 2002 that was 7 times
that of private industry as a whole.
- Occupational skin diseases or disorders account for approximately 15 percent
of nonfatal occupational illnesses, the second largest category after repetitive
trauma. Dermatitis—skin inflammation resulting from contact with allergens
or irritant substances—accounts for more than 75 percent of cases of
occupational skin diseases or disorders that are accompanied by days away from
work.
- In spite of the general downward trend in pneumoconiosis deaths, deaths from
asbestosis increased from about 100 in 1974 to more than 1,200 in 2000, probably
due in part to the increase
in the disease associated with historical exposures to asbestos and in part
to increased recognition of the disease by physicians. This upward trend is
not expected to peak and reverse for at least 10 years.
- Apart from the language barrier, newly immigrated workers face other special
challenges in the work environment, such as unfamiliarity with laws and labor
standards in the United States.
- The average work year for prime-age working couples has increased by nearly
700 hours in the past two decades, and high levels of emotional exhaustion
are the norm for 20 to 30 percent of the workforce.
- By 2010, an estimated 40 percent of the U.S. workforce will be aged 45 years
and older. Older workers are at increased risk for fatal work injuries, require
more time to return to work following an injury or illness, and are less likely
to receive training as their jobs change.
Current Strategies
NIOSH Director John Howard introduced the principal themes that
would focus subsequent discussion of activities under way to meet
critical challenges to workers’ health and safety. Dr. Howard
noted that NIOSH has been engaged since 1996 in the National Occupational
Research Agenda (NORA), a major effort that contributes to progress
made toward achieving the Healthy People 2010 objectives for occupational
safety and health. Through NORA, NIOSH and collaborating public
and private partners provide a framework to guide occupational
safety and health research in 21 high-impact priority areas, such
as traumatic injury, chronic obstructive pulmonary disease, asthma,
and control technology. Among the principal current activities
and innovations under way to enhance the state of occupational
safety and health, the following were discussed during the review:
- In response to concerns expressed by employees, employee representatives,
employers, or state or Federal agencies, NIOSH conducts Health Hazard Evaluations
to determine whether there is an unsafe situation in a workplace caused by
new or poorly understood materials or conditions, such as chemicals, biological
agents, heat stress, noise, radiation, and ergonomic stressors. NIOSH disseminates
results and recommendations from these evaluations in English and Spanish.
- To address fatalities in high-risk industries such as mining, NIOSH develops
and implements targeted interventions such as roof support technologies in
underground mines and proximity detection systems for large equipment hazards.
- In cooperation with partners, NIOSH developed the Personal Dust Monitor,
a wearable device that provides a real-time readout of exposure data during
and immediately after a worker’s shift, unlike previous technology that
required weeks to process samples. Similar technologies can be developed to
monitor other exposure hazards.
- As part of its efforts to reduce health disparities, NIOSH developed a Spanish-language
Web site, “NIOSH en Español,” to meet the needs of the Hispanic
worker population, which is expected to increase by more than one-third during
the next decade. The site provides translations of selected NIOSH publications
and links to other Spanish-language materials, as well as referral to a toll-free
telephone number for followup inquiries.
- To address violence in the workplace, NIOSH took the lead in creating the
Federal Interagency Task Force on Workplace Violence Research and Prevention.
The task force provides a forum for sharing information and identifying opportunities
for collaborative efforts on the part of NIOSH and its partners on the task
force—the Departments of Labor and Justice and 20 other Federal agencies.
A conference on best practices for preventing workplace violence is planned
for the fall of 2004.
- In the spirit of the HHS Steps to a HealthierUS initiative, NIOSH introduced
the Steps to a HealthierUS Workforce to encourage workplace health programs
that focus on both risk factors in places of employment and the promotion of
healthy lifestyles to reduce and prevent chronic disease. A national symposium
will be held in September 2004.
Approaches for Consideration
During the review, the following suggestions were made for steps
to bring about further progress toward achievement of the objectives:
- Give greater attention to determining the prevalence, source, and nature
of disability from occupational injuries and illnesses and to preventing
its occurrence.
- Explore the possibility of reviving the Quality of Employment Survey,
which was administered on three occasions during the early 1970s and yielded
valuable information about the organizational aspects of working conditions.
- Undertake additional efforts to address health disparities, such as higher
occupational mortality and injury rates, by targeting interventions to specific
populations at risk, such as older, young, and immigrant workers.
- Develop strategies for prevention of needlestick injuries sustained by
non-hospital-based healthcare workers.
Contacts for information about Healthy People 2010
focus area 20—Occupational Safety and Health:
- National Institute for Occupational Safety and Health/CDC—Regina Pana-Cryan, rfp2@cdc.gov
- Office of Disease Prevention and Health Promotion (coordinator of the Progress
Reviews)—Ellis Davis (liaison
to the focus area 20 workgroup),
ellis.davis@hhs.gov
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Cristina V. Beato, M.D.
Acting Assistant Secretary for Health
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