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Getting Closer to Understanding the Economic Burden of Occupational Injury and Illness
A recently published landmark paper by J. Paul Leigh (Milbank Quarterly 2011 89 (6):728-772) makes a significant contribution to understanding the economic burden of occupational illness and injury. The paper entitled “Economic Burden of Occupational Injury and Illness in the United States” shows that the annual direct and indirect costs are at least $250 billion. This amount exceeds the individual cost of cancer, coronary heart disease, stroke, and diabetes. As Leigh notes, the cost of injury, illness, and death from these other diseases are generally easier to assess because they require a small number of primary data sources, typically 1 to 4. In contrast, estimates of the burden of occupational injury and illness are more difficult to accomplish because they rely on far more primary and secondary sources of data on more than 18 diseases and a substantial number of injury types. In fact, Leigh used more than 40 data sets in conducting this rigorous analysis. While the Leigh study is the most comprehensive analysis of the burden of occupational illness and injury in the U.S. ever conducted, the estimates, due to methodologic issues inherent in the data, still do not capture the full economic burden. As Leigh indicated, the cost estimates did not include:
Although these exclusions were justifiable for methodological reasons, the study finding of a $250 billion economic burden is an underestimate of the true burden of occupational illness and injury. Additionally, the Leigh study does not include the costs resulting from the interaction of occupational and personal risk factors (see previous blog: A Comprehensive Approach to Workforce Health) that lead to many diseases of public health importance. The paper by Leigh is a scholarly advance and the most rigorous to date, but due to the lack of complete data on the prevalence, incidence, and costs of all occupational illnesses and injuries, further methodological work is needed to capture, among other factors, the true attributable fraction. Identifying these exclusions and limitations of this study highlights the point that there is still much work to do in characterizing the true economic burden of occupational injury and illness. This paper is a major step in illustrating the economic burden of occupational injury and illness and how this affects the economic health of the nation and the productivity of the workforce. Leigh observes that the cost of job-related injuries and illnesses are greater than generally assumed. However, the national investment in addressing occupational illness and injuries is far less than for many other diseases with lower economic burden even though occupational illnesses and injuries are eminently preventable. As mentioned in the description of the NIOSH Economics Program the Occupational Safety and Health Act of 1970 (the Act) states: “The Congress finds that personal injuries and illnesses arising out of work situations impose a substantial burden upon, and are a hindrance to, interstate commerce in terms of lost production, wage loss, medical expenses, and disability compensation payments.” [Section (2)(a)] The paper by Leigh quantified the extent of that burden, which in part motivated the passage of the Occupational Safety and Health Act, and shows that this burden is still significant today. We welcome your comments and observations on the burden and the appropriate response to these observations.
Dr. Schulte is the Director of the NIOSH Education and Information Division.
Dr. Biddle is a Senior Research Economist in the NIOSH Division of Safety Research.
Mr. Hearl is the NIOSH Economics Program Manager and the Chief of Staff in the NIOSH Office of the Director.
Local Exhaust Ventilation for the Control of Welding Fumes in the Construction Industry
Arc welding is a common unit operation in the construction industry, where frequent changes in location and welding position make it more difficult to control fume exposures than in industries where fixed locations are the norm. Welders may be exposed to a variety of toxic airborne contaminants including manganese (Mn) and hexavalent chromium (CrVI). Local exhaust ventilation (LEV) is a well-known engineering control for welding fumes but has not been adopted widely in the construction industry. This literature review presents data on the performance of a variety of LEV systems for welding fume control from the construction (five references), shipyard (five references), and other industries. The studies indicate that LEV can reduce fume exposures to total particulate, Mn, and CrVI to levels below currently relevant standards. Field studies suggest that 40–50% or more reduction in exposure is possible with portable or fixed LEV systems relative to natural ventilation but that correct positioning of the hood and adequate exhaust flow rates are essential. Successful implementation of extraction guns for gas metal arc welding (GMAW) and flux core arc welding has been demonstrated, indicating that a successful balance between extraction airflow and shielding gas requirements is possible. Work practices are an important part of achieving successful control of fume exposures; in particular, positioning the hood close to the arc, checking exhaust flow rates, and avoiding the plume. Further research is needed on hood size effects for controlling welding fume with portable LEV systems and identifying and overcoming barriers to LEV use in construction. Click Here for more.
Los Angeles Fire Department joins Cal/OSHA’s confined space awareness campaign
Cal/OSHA has teamed up with the Los Angeles Fire Department to educate employers and employees on the dangers of working in confined spaces. The news conference included examples of potential hazards and a confined space rescue demonstration by the Los Angeles Fire Department. Cal/OSHA launched a statewide confined space awareness campaign in February with the goal of helping employers and workers understand the hazards of confined spaces. The campaign was sparked by seven confined space deaths and numerous injuries in 2011—including several in the greater Los Angeles region – all of which were preventable. Cal/OSHA is taking a comprehensive approach to prevent these deaths and injuries in California through widespread public education and media alerts, enforcement and consultation, and ongoing partnerships to help increase awareness and compliance. “Confined spaces” are enclosed spaces that can be entered by workers, but have limited openings for entry or exit, and are not designed for continuous worker occupancy. Common examples include tanks, silos, pipelines, sewers, storage bins, drain tunnels and vaults. Confined spaces can be found in many industries and also in non-industrial workplaces. For example, the 2011 California deaths occurred in a wide range of industries—a Fortune 500 pharmaceutical facility, a winery, a paint manufacturing plant, and a recycling center. One of these incidents occurred last January at Baxter Biosciences, a pharmaceutical manufacturer in Los Angeles. A 33-year old technician entered a blood plasma tank to measure its contents when he collapsed in the oxygen deficient atmosphere. Two of his colleagues entered the tank in order to attempt a rescue and collapsed as well. All three workers were extricated from the tank by the Los Angeles Fire Department. The first worker died, the second remains unconscious, and the third was injured but recovered. Last October, a similar scenario occurred at the Community Recycling & Recovery facility in Lamont, when a 16-year-old worker cleaning a drainage tunnel was overcome by hydrogen sulfide gas. Another worker—his brother, aged 22—rushed in to save him and was also overcome. Both workers died. Last week, Cal/OSHA levied fines totaling $166,890 for multiple violations of confined space regulations against the employer. Cal/OSHA’s criminal investigation in this case is still ongoing. Cal/OSHA has posted extensive information about confined space hazards on its website www.dir.ca.gov/dosh/confinedspace. These materials include a webinar for employers and employees on hazards and safe work practices. Cal/OSHA will be providing other training and outreach programs throughout the year to educate employers and employees in hopes of preventing workplacedeaths and injuries. For more help on working safely in confined spaces, contact the Cal/OSHA Consultation Service toll-free at 1-800-963-9424. This service is free and confidential. More information is available online atwww.dir.ca.gov/dosh/consultation.html. Employees with work-related questions or complaints can call the California Workers’ Information Hotline at 1-866-924-9757.
Oregon OSHA - Proposed Changes To Confined Spaces in General Industry and Construction
Oregon OSHA proposes to adopt new rule, OAR 437-002-0146 Confined Spaces, which replaces 1910.146 Permit-Required Confined Spaces, in Division 2/J General Environmental Controls. This expands the scope of the new rule to include the construction industry. During the 2011 proposal, several issues were discovered that needed to be resolved. We
reconvened our stakeholder groups to resolve those issues and address any other areas for clarification. The identified issues include: revising and including several definitions, language for closing permits, ensuring employee access to written materials, ensuring all actions required by the permit are followed, and clarifying when alternate entry cannot be used. Other areas amended for clarification include:
Permit Space Program
Added language on what to do if entrants need to evacuate a permit space.
There was language requiring patient decontamination. The group consensus was to move this language to the appendix on rescue. In its place, language was added requiring MSDSs and providing them to the medical providers.
Moved the awareness training piece to the bottom of the training section to avoid confusion and clarified that it is only for employees who work around permit spaces.
Modified the record retention section to refer back to the rule that requires a review of the permit program.
The requirements of this standard are similar to the requirements of the existing general industry standard, but are written to clarify employer obligations and eliminate confusing requirements. This rulemaking will amend Oregon-initiated rules OAR 437-002-0182, 437-002-0256, and 437-002-0312 to update the rule reference to the new Oregon rule 437-002-0146 Confined Spaces. Also amended to reflect the new Confined Spaces rules are 1910.120 Appendix E, and 1910.269 that currently refer the reader to 1910.146. We will also repeal 1926.21(b)(6) in Division 3/C, and place a note referring the reader to Division 2/J, 437-002-0146 Confined Spaces.
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Civilian Fire Fatalities
On April 1, 2012, 9 residential fire fatalities were reported by news media throughout the United States.
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