Occupational Health Research Paper

Although work has inherent hazards, working is fundamentally positive. It provides food, clothing, and shelter, creates cities and transportation systems, and forms the basis for human civilization. Work shapes society and profoundly affects the person conducting it. To the extent that workers gain income and other benefits, accomplishment, and social engagement, they share in the positive aspects of work. However, benefits to the individual and to society must include the systematic development of hazard identification and intervention to prevent the illnesses, injuries, and loss of life that unfortunately continue to characterize this important human activity.

Hazards

By definition, all work requires energy transfer and therefore generates hazards. The potential for hazardous exposures to uncontrolled energy, as well as to chemical, physical, biological, mechanical, or psychological stressors is universal, recognizable, and preventable. The adverse impact of human activity extends to nonoccupational environmental settings as well, and is discussed elsewhere.

Safety hazards occur when there is opportunity for uncontrolled energy transfer to a vulnerable worker. Sources of energy may be kinetic, thermal, chemical, electrical, or radioactive. These hazards are considered to result in injury instantaneously, although that is actually a fairly loosely applied term. Injury outcomes may be classified by type of injury sustained (e.g., burn, fracture, etc.), by body part affected (e.g., back, head, etc.), by source of injury (e.g. tractor, automobile, knife), or by event (e.g., fire, transportation accident, contact with equipment, falls, bodily exertion).

Health hazards typically occur over a longer period of time and result in diseases rather than injuries, although different classification systems use different terminologies. By convention, the major types of health hazard are listed as follows:

• Biologic hazards include exposures to living organisms and may or may not be communicable (readily transmitted to others). Viruses, bacteria, fungi, rickettsia, Chlamydia, protozoa, helminths, and now prions have been demonstrated to produce occupational and environmental illnesses. Toxins, which are large organic molecules elaborated by living organisms, may be included under the grouping of biologic hazard, but more often are listed with chemical hazards. Workers at higher risk of exposure to biologic hazards include those who work with people (health-care workers, child-care workers, laboratory workers), those who work with animals (agricultural workers, laboratory workers, zookeepers), those exposed to unfamiliar pathogens through travel (business travelers, migrant workers, military), those who work or live in large groups (military recruits, college students), and those who move soil (construction workers, farmers).
• Chemical hazards consist of synthetic or naturally occurring chemicals that come in contact with the skin, respiratory tract, or gut (or, rarely, through inoculation). Chemicals may exert toxic effects by interacting with a receptor site in these organs, by interacting with receptor sites elsewhere in the body following absorption, or both. Toxic substances, also called toxicants or xenobiotics, may be absorbed, distributed, stored, metabolized, and excreted. Adverse outcomes from exposure may be enhanced or reduced by metabolic transformation, which primarily acts to promote excretion of the toxicant. Exposure may be acute, subacute, or chronic in duration, and outcomes may be transient, persistent, cumulative, or latent. In addition to producing irritant, sensitizing or organ-specific damage, specific chemical exposures may cause genetic damage that may lead to adverse reproductive outcomes or they may induce or promote changes that lead to cancer.
• Physical hazards are measured through physics, and include noise, vibration, temperature extremes, hyperbaric and hypobaric atmospheres, and ionizing and nonionizing radiation.
• Mechanical hazards or biomechanical hazards are the most commonly encountered hazardous exposure in most workplaces, and include sustained or repetitive exertion that exceeds the individual’s capacity to recover. Force, frequency, and posture contribute to the workload and determine the frequency of adverse musculoskeletal outcomes.
• Psychological hazards are gaining recognition as important predictors of cardiovascular status as well as mental health outcomes. Hazard classification systems range from direct or indirect exposure to major traumatic events to generalized or specific forms of workplace harassment to factors related to work organization, such as work demands, control, and rewards.

Outcomes

Occupational exposures cause virtually all forms of acute traumatic injury and an extraordinary range of diseases affecting all major organ systems through most known disease-producing mechanisms. Within this broad array of health outcomes, the most prevalent outcomes result from repeated exposures to hazards, including noise-induced hearing loss, low back syndromes, upper-extremity musculoskeletal disorders, acute local responses to skin exposures (contact irritant and contact allergic dermatitis) and to respiratory exposures (upper respiratory irritant and allergic responses and irritant and allergic asthma). Occupational exposures alone or in combination with other environmental or genetic factors produce cardiovascular disease and stroke, adverse central nervous system outcomes, liver and kidney disease, and a variety of cancers. Furthermore, systemic poisoning caused by workplace exposures may cause recognized illness and death or may result in subtle population effects, such as slightly diminished IQ measures or slightly increased blood pressure determinations as measured across a group.

Finally, both unemployment and the threat of involuntary loss of work adversely affect health and well-being (Dooley et al., 1996), as demonstrated by the increased mortality rates for middle-aged men in the newly emerging states of the former Soviet Union as jobs became insecure. A recent study from Finland suggests that the threat of involuntary job loss has adverse effects on men more than for women, as measured by prescription medication usage for both psychotropic medications and for all medications in the wake of job loss. Furthermore, this study demonstrated increased use of psychotropic medications among co-workers who did not lose their jobs, highlighting the importance of job security to human well-being (Kivimaki et al., 2007). Ecologic studies have identified community markers of increased cardiovascular mortality to include unemployment (Armstrong et al., 2003). The widened gap between the health status of employed and unemployed persons in minority communities in the United States may cause an exaggerated healthy worker effect that obscures the impact of occupational exposures on health outcomes and that supports the importance work plays in overall health.

Scope Of The Problem

An accurate assessment of the global burden of work-related illness and injury would require better surveillance systems than currently exist in most countries. Recent attempts to estimate the global burden of fatal occupational injuries and illnesses suggest that workplace hazards cause more deaths worldwide than either childhood illnesses or infectious diseases (Hamalainen et al., 2006, 2007). By developing and applying attributable occupational fractions to estimates of global diseases for seven major categories (communicable diseases, malignant neoplasms, respiratory system diseases, circulatory system diseases, neuropsychiatric conditions, digestive system diseases, and genitourinary system diseases) Hamalainen et al. estimate that two million work-related deaths occur annually, including approximately 346 000 from traumatic injury. This estimate includes higher rates of mortality from communicable diseases in India and China and a higher attributable fraction of mortality from cardiovascular disease and malignant neoplasms in developed countries with longer life expectancies that allow for diseases with longer latencies to emerge.

Nonfatal work-related illnesses and injuries have enormous economic consequences to the individual workers and their families as well as to the employer and to society. Beyond the economic impact of the estimated 264 million nonfatal work injuries sustained each year is the emotional toll on workers and family members, including increased divorce rates, decreased school performance, and increased rates of mental health disorders.

Globalization Of Work And Of The Workforce

Downsizing, outsourcing, the globalization of industry, and trade agreements that aim to reduce barriers to trade, have radically transformed the production and distribution of goods and services over the past quarter century and have created challenges for effective implementation of occupational safety and health protections.

Demographic changes in industrialized countries include the aging of the endogenous workforce accompanied by the inclusion of women in the paid workforce, varying levels of integration of workers who would previously have been excluded, including those with physical or mental impairments and preexisting diseases (such as cancer survivors), and a dramatic increase in the use of immigrant labor.

Labor migration is a global phenomenon. Within country migration may occur as a result of urbanization and industrialization, or may result from development of extraction industries in previously unpopulated areas. Between-country migration is generally the result of a mismatch between job availability and worker location and may involve highly skilled or unskilled labor. Adverse health effects directly attributable to migration include infectious diseases caused by unaccustomed exposures and living conditions, diseases caused by social disruption, and diseases that result from neglect. Workers who have language difficulties may experience difficulties understanding instructions or safety training, may face overt discrimination, or may be marginalized into exploitative working arrangements. Migrant workers who lack documentation are less likely to seek regulatory protection when these are available. The number of fatal occupational injuries to foreign-born workers in the United States has risen significantly since 1995, as have numbers of immigrants and rates of fatalities (Richardson et al., 2003; Loh and Richardson, 2004). Foreign-born Hispanic workers experienced a fatal occupational injury rate of 6.1 per 100 000 from 1996 through 2000, compared with rates for U.S.-born Hispanic workers (4.5/100 000) and all U.S. workers (4.6/100 000) that were one-third less. Of the foreign-born Hispanic workers killed on the job, 69% were born in Mexico.

The globalization of trade has led to significant tension between the need to reduce trade barriers on the one hand and protections for working populations on the other. The tension between free trade agreements and health and safety protections is not limited to occupational or environmental considerations. Concerns have been raised about loss of jobs, particularly in subsistence farming in developing countries, and the outsourcing of manufacturing employment from industrialized countries to countries with progressively lower wage structures, generally accompanied by fewer safety and health protections.

In addition to the international aspects of mergers, downsizing and outsourcing, the emergence of significant pools of informal or contingent labor within a given worksite has a number of impacts. These create confusion about authority and responsibility, which effectively leads to a loss of attention to and control of hazardous exposures.

Contingent or precarious work situations have increased and cover a wide spectrum of working arrangements, such as part-time work, temporary help, service employment, employee leasing, self-employment, contracting out, employment in the business services sector, day labor and home-based work. A review of 27 studies exploring the relation between temporary work and health outcomes identified increased adverse mental health outcomes but reduced sick absences, and identified different outcomes based on the labor structure within the country studied, suggesting greater adverse physical outcomes in countries where the temporary labor force is more marginalized (Virtanen et al., 2005). Quinlan and others have described increases in precarious employment that is associated with adverse health and safety outcomes (Mayhew and Quinlan, 1999; Quinlan et al., 2001). Contingent work arrangements may diffuse employer responsibility; at worst, they become undeclared work completely outside of formal government oversight. Disorganization and economic incentives negatively impact record-keeping for occupational illness and injury. Benavides et al. (2006) explored the increased rate ratio of fatal and nonfatal traumatic injuries among temporary workers in Spain and determined that these differences were largely accounted for by occupation and by job tenure, suggesting general safety and health measures and enhanced workplace safety and health training as interventions.

Youth And Older Workers

The issue of youth at work has received attention internationally. The International Labour Organization (ILO), a special agency of the United Nations, has adopted the abolition of child labor as one of its four goals of the Fundamental Principles and Rights at Work (International Labour Organization, 1998). In their recent publication, ‘‘Global Report: The End of Child Labour: Within Reach’’ (International Labour Organization, 2006), they reported progress over a 4-year period from 2000 to 2004, with an 11% decrease in numbers of child laborers globally. They reported a 33% decrease in 5to 14-year-olds doing hazardous work. Areas cited for the most progress were Latin American and the Caribbean, while subSaharan Africa had made the least progress. In developed countries, there are more likely to be laws, standards, and regulations to protect youth at work, although enforcement may be variable. In the United States, the Fair Labor Standard of 1938, administered by the Department of Labor, sets hour limits for workers younger than 16 and restricts those under 18 from some hazardous occupations. However, these limits do not apply to youth performing agricultural work and enforcement is variable. Specific state laws may also apply to work hour and work type limits. In the United States, a large proportion of youth attending 7th and 8th grades (40%) and high school (80%) report that they work (National Research Council and Institute of Medicine, 1998). The largest proportion is employed in retail (restaurants, fast food, grocery stores), followed by the service sector, agriculture, and construction. It has been estimated that approximately 100 000 youth require emergency room treatment for work-related injuries each year. The nonfatal injury rate per 100 full-time equivalents (FTE) is higher in youth than in adults (4.9 vs 2.8/ 100 FTE), mostly occurring in retail and services sectors. Fatal injuries, numbering approximately 67 annually, occur disproportionately in agriculture/forestry/fishing and construction (NIOSH, 2004a). The chief causes are transportation incidents, equipment, and assaults. Recommendations from a recent report (NIOSH, 2004b) include better surveillance and databases, coordinated action by the Departments of Labor and Education, and consideration of changes to laws on work hours, hazardous work, and agricultural work.

At the other end of life in some developed countries, there will be more workers in older age groups because of later retirement, economic necessity, longer life expectancies, and the aging of the population bulge born between 1946 and 1965. There are concerns that normative aging changes and underlying chronic medical conditions may affect older workers’ ability to carry out their work. Data from the Worker Health Chart Book (NIOSH, 2004b) suggest that, although workers older than 64 have lower rates of occupational injury and illness than younger workers, the resulting morbidity is higher, as measured by days away from work. The rates of fatal injuries are roughly three times higher for those over 64 compared with those aged 20–64. As reported by the National Research Council and the Institute of Medicine (Wegman and McGee, 2004), needed research areas include improved data (including data on costs of occupational injury and illness in older workers); targeted research on exposures, effects of chronic underlying health conditions; and identification and evaluation of interventions (including public policies, job design, training, accommodations, and worksite health promotion.

Public Health Approach

Occupational health is a public health discipline based on the principles of assessment, intervention, and assurance, with prevention as the goal. Primary prevention identifies a hazard and either (1) prevents susceptible individuals from becoming exposed to it (usually through engineering interventions or substitution) or (2) strengthens the individual, such as through immunization. Secondary prevention identifies early evidence of a disease (usually by screening) at a stage where intervention (such as by medical treatment) can cure or prevent further progression of the disease. Tertiary prevention attempts to reduce the impact of illness or injury and associated disability, such as through medical care, rehabilitation, or environmental or workplace adaptation. All of these approaches require effective communication and information-sharing among a wide range of public health and health-care professionals. Areas of scientific expertise within public health that may be brought to bear to prevent illness and injury include industrial hygiene, epidemiology, safety, environmental engineering, toxicology, occupational medicine, occupational health nursing, sanitation, psychology, ergonomics, health and safety educators, and the frontline expertise of workers and managers. Within occupational health care, screening and surveillance are directed toward identification of health events or documentation of early evidence for adverse health effects that have already occurred. Both screening and surveillance can lead to primary prevention measures: Screening, through the early detection of disease or abnormality at a stage when preventive action can reduce the likelihood that the individual worker will develop an irreversible adverse outcome, and surveillance, which is the use of grouped data or sentinel events that can identify inadequate control measures that impact a group of workers, allowing breaches in control to be corrected. Although the terms are often used interchangeably, it is helpful to distinguish screening as having the individual worker as the focus. Medical screening seeks to identify asymptomatic abnormalities in an individual at a stage when intervention may prevent a clinically apparent adverse outcome. The intervention may be preventive, such as removing a worker from an exposure, or it may be therapeutic, as with postexposure chemoprophylaxis for latent infection with Mycobacterium tuberculosis. Criteria for effective screening programs exist, and include the safety of the screening tool and the intervention, the positive and negative predictive value of the tests (based on the prevalence of the underlying condition as well as the test precision), and the risks and benefits of any potential treatment. Surveillance programs may include the same activities as screening programs (for example, spirometry testing for populations potentially exposed to respiratory hazards), but the goal for surveillance programs is to identify abnormalities that indicate an exposure problem across the working population in order to attempt to correct the exposure. Surveillance programs therefore examine aggregated data to identify trends that suggest problems in a working population even when no individual worker’s testing result reaches a threshold requiring removal or treatment. Surveillance programs also incorporate the identification of outlier events that indicate severe systems problems (sentinel events) in addition to monitoring aggregate data.

Prevention requires a systematic approach, effective communication, and constant feedback. In public health, the steps include (1) gathering information about exposures and outcomes (surveillance); (2) identifying problems; (3) developing, communicating, and implementing strategies for improvement; and (4) evaluating the outcome of the strategies.

Accurate data are critical to identify problems as well as to shape interventions and to measure the effectiveness of these interventions. Inaccurate or absent data challenge the integrity of any occupational health system. Small firms, which lack the resources and expertise of large companies, have typically the highest rates of fatal traumatic injuries when compared with mid-sized or large firms. Because reporting for fatal injuries is generally considered to be complete, the relationship between size of firm and traumatic injury mortality rate (not numbers) appears to be inverse and linear.

However, the opposite is true for reported occupational illnesses. These outcomes, which may include common conditions such as asthma and dermatitis, often require occupational expertise to be correctly recognized as work-related. The virtual absence of reported occupational illness among employees in smaller companies strongly suggests failure to recognize or report and calls into question the accuracy of existing surveillance mechanisms.

Several of the changes described earlier in this research paper, including the increase in immigrant and contingent labor, also impact data collection, as do systems that fail to include verification steps or that encourage underreporting. As an example, a U.S. Government Accountability Office report in 2005 describing major changes in the poultry and meat-packing industry over the past two decades links the increase in contingent workers, who now comprise fully one-third of workers in this industry, with decreases in union representation and wages, an increase in immigrant workers and in worker turnover and a precipitous decline in reported illness and injury rates, attributed to undercounting (U.S. Government Accountability Office, 2005).

In this report, the GAO raised concerns that the steep drop in reported illnesses and injuries was due to underreporting and that it may have been inadvertently encouraged by Occupational Safety and Health Administration (OSHA) policies targeting industries with high rates of self-reported illnesses and injuries for potential inspection and sanctions without at the same time providing meaningful third party verification of reporting through adequate inspections. The GAO made recommendations to improve this data collection concern through the following changes:

• Adjust the OSHA criteria for targeting work sites for inspections and record audits to include sites with large reductions over time (in addition to sites with high recorded injury rates);
• Require multiple-year trend data and data on subcontractors (including cleaning and maintenance subcontractors);
• Require a common identifier.

Government Role

Like other public health functions, assuring occupational safety and health requires government involvement in both of the basic responsibilities of any government, to provide services and to impose obligations. These responsibilities may be shared by ministries of labor and health. In the United States, the federal Occupational Safety and Health Administration, within the U.S. Department of Labor, has primary responsibility for establishing and enforcing minimum occupational safety and health standards, although a number of other entities are also engaged in this task for various segments of the workforce.

The Occupational Safety and Health Act of 1970 created the Occupational Safety and Health Administration (OSHA) within the Department of Labor and the National Institute for Occupational Safety and Health (NIOSH) within the Department of Health and Human Services (then Health, Education and Welfare), subsequently incorporated as part of the Centers for Disease Control and Prevention. This division was created to permit NIOSH to focus on research, but in some ways it reflects the different cultures found within the International Labour Office and the World Health Organization. OSHA is the larger agency, although it remains very small by comparison with other federal entities. OSHA’s primary responsibility is to develop and enforce regulations that protect workers, but it also provides technical assistance and consultation to business owners and educational and training services to workers and managers. NIOSH is approximately half the size of OSHA and has responsibility for creating knowledge through basic and applied research, training professionals, creating the scientific basis for regulatory activity, and providing technical assistance. Both agencies receive a fraction of the funding provided to similar nonoccupational entities. For example, OSHA’s budget is approximately 10% that of the Environmental Protection Agency, and NIOSH receives less than half the funding provided to the National Institute of Environmental Health Sciences, agencies that many scientists consider to be underfunded.

Because a number of states had already developed safety and health programs prior to 1970, they were allowed the option to continue to operate these programs, with additional federal funding, as state OSHA plans that take the place of the federal program. To do this, states must have at least as stringent rules as the federal OSHA and accept responsibility for enforcement. Federal OSHA has a national directorate that coordinates and facilitates communication among all of the state OSHA plans, and the state programs communicate through the federal regions. Currently 23 states and two territories have their own programs (four of these cover public employees only).

Because of constitutional and self-imposed limitations on the power of the federal government, OSHA has no enforcement authority over the following groups of workers:

• State and local government employees in federal plan states;
• Federal employees (although they are covered by executive order);
• Family-owned farms, self-employed individuals.

Furthermore, OSHA is not able to enforce safety and health standards when other branches of the federal government are responsible for safety, for example, in the aviation industry.

Within the Department of Labor (DOL), OSHA is one of many units that also include:

• Bureau of Labor and Statistics;
• Employment Standards Administration;
• Employment and Training Administration;
• Job Corps;
• Mining Safety and Health Administration;
• Employment Benefits and Security, Administrative Law, Disability Employment, Women’s Bureau, International Labor Affairs, etc.

These agencies share responsibility for data-gathering, training, wage and hour regulations and enforcement, and other activities that impact working life. The Mining Safety and Health Administration most closely parallels OSHA in its focus on safety and health. Although not as directly impacted by many of the global factors described above, the fragmentation of the mining industry into smaller, less-often-unionized operations is a parallel change that appears to be associated with a recent increase in fatal traumatic injuries following nearly a century of improved outcomes in this extremely dangerous occupation.

The OSHA standard-setting process is lengthy and involves publishing an Advance Notice of Proposed Rulemaking, conducting public meetings and soliciting written comments to a docket, issuing a proposed rule, holding additional public meetings and soliciting additional comments to a formal legal docket, limiting burdens to small businesses through congressionally mandated protocols, as well as following requirements for paperwork reduction. The purpose of these many steps is to assure that all sectors of society have adequate input into the regulatory process, yet despite all of this, each standard that is finally promulgated is inevitably subject to immediate court challenge. The contentious and very slow nature of the process has been problematic since OSHA’s inception, but has worsened over the decades.

OSHA’s regulatory history has been generally substance-specific, dating from the initial adoption of prevailing consensus standards to subsequent individual standards:

• Asbestos – the initial exposure levels failed to address carcinogenesis; although these exposure levels were successfully reduced in subsequent standard updates. Note that OSHA does not have the ability to propose an outright substance ban; however, when the Environmental Protection Agency, which does have the authority, attempted to ban asbestos, the attempt failed legal challenge. Efforts to ban asbestos have been successful in other countries and a global effort is now underway, with renewed attention in the U.S. Senate.
• Carcinogen Standard – adopted as a block of 14 chemicals, to date the largest grouping in a single standard.
• Lead – provided the worker with medical removal protection when blood lead levels exceeded certain amounts (now generally agreed to be too high, because the target levels have not changed as new information has been developed over the years).
• Benzene – challenged in court, following which OSHA was required to demonstrate significant risk (death or adverse impact affecting approximately 1 in 1000 workers) to justify lowered exposure levels.
• Vinyl chloride – this standard was allowed even though it was technology forcing, requiring the industry to develop new technology to reach the exposure limits required.
• Ergonomics – the first regulation promulgated by the executive branch that was rescinded by a specific act of Congress.

While the existing OSHA standards have been extremely important for reducing safety and health hazards, the difficulty in developing and implementing new standards has been problematic. An alternative approach is the development of broader standards that address larger issues. One of the broad concerns raised by the occupational safety and health community was the difficulty workers and their representatives initially faced in identifying hazards in the workplace. In the early 1980s, large coalitions of unions, firefighters, and community groups raised concerns about the right to know about hazardous chemical exposures in communities and workplaces. Because of the lack of response at the federal level, efforts targeted enacting legislation at the state level, based on an absence of information about the following:

• Workplace exposures, brand names, trade secrets;
• Community exposures, chronic or acute;
• Acute and chronic health hazards;
• Fire and explosion hazards;
• First aid and disaster response information;
• Appropriate preventive measures and personal protective equipment.

The disaster at Bhopal, India, in which thousands died and many more sustained permanent respiratory and eye damage when a runaway chemical reaction at a pesticide manufacturing plant released a cloud of methyl isocyanate and other toxic gases onto nearby communities in the middle of the night, galvanized public opinion. The facility was a subsidiary of the U.S.-based Union Carbide Corporation, which had previously experienced a near miss at its plant in Institute, West Virginia, which clearly demonstrated the community’s need to know about hazardous exposures. Congress subsequently enacted a series of Right to Know laws (the 1986 Emergency Planning and Community Right to Know Act, and subsequent provisions of the 1990 Clean Air Act Amendments). Of interest, the responsibility for developing worker training programs to carry out hazardous waste clean-up was placed within the research-oriented National Institutes of Health, as an extramurally funded program through the National Institute of Environmental Health Sciences (NIEHS), which funded a series of education-effectiveness studies that helped drive subsequent participatory education approaches that fostered active learning, adult learning, and worker empowerment (McQuiston et al., 1994; Israel et al., 1998).

OSHA adopted a comparable standard, the OSHA Hazard Communications Standard (29 Code of Federal Regulations, 1910.1200), also in 1986. The purpose of the OSHA standard, often referred to as Worker Right to Know, is to ensure that the workers and employers are informed about the hazards associated with all chemicals produced or imported to U.S. workplaces. The standard requires employers to provide comprehensive hazard communication programs, which are to include container labeling and other forms of warning, material safety data sheets, and employee training. While the suppliers of hazardous chemicals are required to provide labeling and material safety data sheets, enforcement has chiefly targeted the availability of this information in a given worksite, rather than the quality of what the manufacturers or importers provide.

The information-sharing required by the standard is important on a number of levels: Basic information about adverse effects of specific exposures conveyed in a manner that the individual is able to use is a form of empowerment. Health educators have developed and evaluated a number of worker training programs that were supported through a variety of federal assistance programs to target hazardous waste workers and others in high-hazard occupations. The engagement of workers and employers in hands-on, active training programs, although not mandated by the standard, were evaluated in a number of fixed industry settings and demonstrated to enhance safety and health hazard identification.

Although the OSHA Hazard Communications Standard was a significant advance, problems persist in the implementation and enforcement of complete programs. Federal OSHA does not require that training take place in a language understood by the trainee, for example, and the quality of the information provided by the material safety data sheets has often been substandard, without quality checks.

In one example, the U.S. Chemical Safety Board investigated an explosion at the Sierra Chemical Company in Nevada in 1998 (U.S. Chemical Safety and Hazard Investigation Board, 1998). Workers had been manufacturing blasting caps for construction using TNT (trinitrotoluene), RDX (hexahydro-1,3,5-trinitro-1,3,5triazine; cyclonite), Composition B (TNT, RDX), HMX (octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine), and PETN (pentaerythritol tetranitrate). Four workers died in the blast and others were evaluated at nearby hospitals. Although the incident was initially treated as a potential criminal investigation, it was quickly determined that a number of occupational issues likely played a role, including evidence of chronic exposure in the form of peripheral cataracts among the survivors and the fact that workers were producing caps on a piecerate system, in addition to problems with procedures and training. All workers had been Spanish-speaking, yet safety training had been conducted in English. Because Nevada is a state-plan state, its state legislature was approached to address the problem and subsequently passed a law requiring safety training to be conducted in a language understood by trainees.

In other examples, problems identified with Material Safety Data Sheets (MSDSs) include inadequate health outcome and missing personal protective equipment information. The death of an environmental chemist who was an internationally known research professor from dimethyl mercury exposure provides a tragic example: The Material Safety Data Sheet, mandated by OSHA, only mentioned nonspecified gloves as a requirement for handling the chemical. The researcher wore latex gloves, which offered no protection; transdermal absorption of a lethal dose resulted in degenerative central nervous system disease and death within 1 year (Nierenberg et al., 1998). As part of an OSHA inspection, the university who employed her and the company selling the chemical were required to conduct the research needed to identify appropriate protection.

Inadequate or incorrect MSDS information has been demonstrated for flammability of waste products and for health hazards such as asthma or fertility impairment. Global harmonization efforts may improve standards, especially to the extent external verification is included.

Generic Safety And Health Programs

The team approach to safety and health training that includes both worker empowerment and management commitment has been demonstrated through a variety of research and voluntary programs to reduce adverse outcomes. The International Labor Office includes comprehensive programs in the definition of safety and health programs, incorporating policy, training, implementation, and documentation and review as an integrated whole, similar to the systems approaches used to verify processes in industrial manufacturing (Alli, 2001). Successful comprehensive programs have been shown to reduce back injuries among orderlies in an urban hospital, dermatitis among manufacturing workers, and sharps-related injuries among health-care workers (Evanoff et al., 1999; Gershon et al., 2000; Held et al., 2002). Unfortunately, this constitutes OSHA’s Missing Standard: Generic Health and Safety Programs. Although there was a belated attempt to develop what many believe should have been the first generic standard in 1989 with an advance notice of proposed rulemaking, after more than 10 years, this draft standard was removed from OSHA rule making. It would have relied on the concepts used in voluntary programs: Complete programs with quality improvement aspects. These require data, transparency, and participation and are based on a systems approach similar to ISO 14 000. The OSHA failure reflects the failed ISO 15 000 attempt, which was derailed by national and international political and economic challenges.

OSHA’s Proposed Generic Safety and Health Standard would have included the following components (note there was no provision for medical surveillance, which was initially proposed as a separate entity, which also failed):

• Management leadership and participation: Establish the responsibilities of managers, supervisors, and others for managing safety and health; provide authority, information, and training commensurate with responsibilities; identify individuals to receive reports and initiate corrective action.
• Employee participation: Ongoing, effective communication, employee involvement, reporting and recommendations, with prompt employer response.
• Hazard assessment: Inspect the workplace and review available safety and health information, conduct incident investigations, utilize checklists, and document.
• Hazard prevention and control: Identify hazards in new equipment, materials and processes, prioritize all hazards based on their seriousness and track progress in controlling them.
• Training program: Include nature of hazards and how to recognize them, employer controls, employee preventive measures, and emergency procedures.
• Evaluation of program effectiveness: Must evaluate pro- gram and revise the program to correct deficiencies – this requires accurate data.

The absence of generic safety and health programs is particularly felt in small businesses. The use of a systems approach to health and safety as a marker of high organizational performance may also serve as a marker of effective performance overall. Evidence of the reverse is certainly true, that poorly performing companies perform poorly across the board. Poor middle management and an absence of corporate leadership in health and safety at Hudson Foods resulted in one of the largest OSHA investigations for ergonomic hazards in the history of the agency. Before Bibliography: could be settled, however, the firm became subject to the largest recall of tainted beef in the history of the United States and was subsequently taken over by another corporation.

One of the main concerns in developing a meaningful generic safety and health program, however, is that the emerging issues that include worker characteristics (migrant, undocumented, older, and younger workers, all of whom may be hesitant to access formal protections), working arrangements (informal, contingent, precarious arrangements), or workplace characteristics (size, type of industry) threaten a race to the bottom in which poor performance is temporarily rewarded, damaging both data and program integrity.

Role Of Organized Labor

Organized labor has had an important role in workplace health and safety. A 2002 report cited evidence of a union effect on occupational health and safety in Canada, Britain, and the United States. This effect was a reduction in workplace injuries related to union-supported health and safety committees at work (Brown, 2002). One of the four aims of the ILO’s Fundamental Principles and Rights at Work is implementation of freedom of association and the right to collective bargaining. In the United States, organized labor has played an important role in advocating and establishing most occupational health and safety regulations, including the OSHA Act of 1970 and OSHA standards, the Coal Mine Health and Safety Act of 1969, the Mine Safety and Health Administration, Bureau of Labor Statistics and the Census of Fatal Occupational Injuries (AFL-CIO Safety and Health Department, 2003). The United Automobile, Aerospace and Agricultural Implement Workers of America (UAW) Union has jointly sponsored research and training with the automobile manufacturers General Motors, Chrysler, and Ford.

In light of the positive historical role organized labor has played, particularly if it is able to improve transparency and address the needs of marginalized working populations, it may yet supply the balance toward safety and health currently missing from the globalizing workplace.

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