PROGRESS REPORT FOR:
Occupational Safety and Health
On March 9, 1995, the Public Health Service (PHS) conducted a review of progress
on Healthy People 2000 objectives for occupational safety and health. The lead agency for
this priority area is the Centers for Disease Control and Prevention. Representatives of
the Health Resources and Services Administration and the National Institutes of Health
were joined for the review by representatives from Organization Resources Counselors,
Inc.; California Medical Center; New York State Department of Health; the University of
Iowa College of Medicine; and the AFL/CIO. Other Federal participants included staff from
the Departments of Labor and Energy, and the Environmental Protection Agency.
The Director of the National Institute for Occupational Safety and Health (NIOSH) began
by emphasizing that occupational injury and disease cause needless human suffering, burden
health care resources, and drain U.S. productivity. In 1994, employers reported 6.3
million disabling work injuries and 514,700 cases of occupational illnesses. In that year,
an average of 18 American workers died each day from injuries on the job. An average of
137 workers died each day from workplace diseases. In 1994, work injuries cost $121
billion in medical care, lost productivity, and wages. Medical payments under workers'
compensation rose to almost $17 billion in 1991 with a total of more than $40 billion paid
in workers' compensation claims.
The number of fatal occupational injuries in the United States has been declining. For
1994, the Bureau of Labor Statistics reported 5 deaths from work-related injuries per
100,000 full-time workers. The 1983-87 baseline was 6 per 100,000. Mortality rates in
mining (including oil and gas extraction), construction, transportation, communication,
public utilities, agriculture, forestry, and fishing are consistently higher than in all
other industries. Rates decreased in nearly every demographic and employment sector, with
greater declines among men, African Americans, and younger workers.
National Traumatic Occupational Fatality (NTOF) data show that homicide is the third
leading cause of traumatic occupational fatalities and that convenience store workers and
taxicab drivers are among those employed in the highest risk occupations. Because of these
findings, a new objective is included in Healthy People 2000 Midcourse Review and 1995
Revisions to reduce deaths from work-related homicides to no more than 0.5 per 100,000
full-time workers from an average of 0.7 per 100,000 during 1980-89.
Rates of work-related nonfatal injuries have increased during the past 6 years.
Compared with the baseline of 7.7 injuries per 100 full-time workers (an average for the
years 1983-87), there were 8.4 cases in 1994. Risks to construction and mine workers have
decreased while on-the-job injury increased among nursing and personal care workers. It is
possible that part of this increase is due to greater awareness and reporting of injuries
such as needle sticks.
A NIOSH study shows that each year 22,000 youths are injured or develop work-related
illnesses, and 64,000 are treated in emergency rooms. About 70 youths suffer fatal
occupational injuries each year. A new Healthy People 2000 special population target is to
reduce injury rates among adolescent workers to 3.8 per 100 from a baseline of 5.8 per 100
in 1992.
New cases of cumulative trauma disorders have increased from 100 cases per 100,000
workers in 1987 to a high of 383 cases per 100,000 workers in 1993. Disorders resulting
from repeated motion, noise-induced hearing loss, and vibration injuries are included, but
lower back disorders are not. Increases in reported cumulative trauma disorders may be due
to heightened awareness and better reporting, but also to changes in work design, such as
increased automation and job specialization, both of which increase the amount of
repetition performed by the worker.
Occupant protection reduces injury in automobile crashes. Data from 1980-89 indicate
that the leading cause of worker fatality was trauma sustained in motor vehicle crashes
(23 percent), ranking ahead of machine-related incidents (14 percent), homicides (12
percent), falls (10 percent), electrocutions (7 percent), and falling objects (7 percent).
The 1992 National Survey of Worksite Health Promotion Activities indicated that 82 percent
of all worksites with 50 or more employees require use of occupant protection. Hence, the
year 2000 target was increased from 75 percent to 95 percent.
Occupational Injury and Disease Burden
Every Day
- 900 workers sustain disabling injuries on the job
- 17 workers die from work-related injuries
- 137 workers die from work-related diseases
In 1994, work injuries alone cost $121 billion in medical expenses and lost
productivity and wages.
Source: Bureau of Labor Statistics, NIOSH Traumatic Occupational Fatalities
Surveillance System, National Safety Council
Depending on data sources, there has been little change over the past 20 years in the
rate of employees who are exposed to damaging levels of noise. Between 1989 and 1993, the
U.S. Air Force Hearing Conservation Database indicates an increase from 16 to nearly 20
percent of workers exposed to average noise levels above 85 decibels. Comprehensive noise
and hearing data are currently being analyzed by the U.S. Army and the United Auto
Workers.
In 1994, 12,137 individuals were reported with blood lead levels greater than 25
micrograms/deciliter. This lead exposure was attributed to the workplace and represents a
7 percent increase over 1993. This increase could be the result of adding two States,
North Carolina and Oklahoma, to the surveillance system (bringing the number of States to
23), or it could be a reporting artifact representing increased awareness and consequent
improved reporting. When extrapolated to the entire United States, this suggests there are
as many as 30,000 individuals with blood lead levels in that range. The incidence of
hepatitis B is decreasing; immunizations among occupationally exposed workers are
increasing.
Federal standards were established in 1969 and 1970 for occupational exposure to
airborne asbestos fibers (which cause asbestosis), cotton dust (which causes byssinosis),
coal mine dust (which causes coal workers' pneumoconiosis), and silica dust (which causes
silicosis). Because these standards apply to all 50 States and U.S. Territories, this
objective is considered to be accomplished. A new objective for tracking mortality from
occupational exposures has been added.
According to the Worksite Health Promotion Survey, 63.8 percent of worksites provide
education on job hazards and injury prevention. The occupational safety and health
programs covered most often at worksites included lifting/back injury (54 percent),
machinery/equipment hazard (37 percent), and general risk/safety management (30 percent).
Despite numerous studies to identify the causes of back injury over the last decade,
little is known of the etiology of low back pain. In the majority of back pain complaints,
no specific, verifiable pathology can be identified with current clinical methods. The
inability to clearly identify and understand the risk factors for low back pain hampers
prevention efforts and the ability to minimize disability. The worksite survey indicates
that 32.5 percent of worksites offer prevention and rehabilitation programs.
Follow-up items from the progress review fall into the three general areas of
surveillance, services and communication. CDC was asked to suggest ways to improve
surveillance systems to detect and monitor emerging problems such as workplace violence
and homicide, safety and health of working children, and occupational asthma. The Health
Care Financing Administration claims data could be used to track injuries and improve
occupational safety and health surveillance. Collaboration among HHS laboratories and
those of other departments should be initiated. CDC should also develop a plan for new
epidemiologic research strategies to assess and confront new occupational safety and
health issues specific to the evolving service sector economy.
To enhance occupational health services, we also need to address the national shortage
of occupational health clinicians and integrate occupational health clinical practices
with primary health care and managed care. The Agency for Healthcare Research and Quality (AHRQ)
should assess the potential for clinical practice guidelines or protocols to assist
primary care providers in assessing occupational health effects. IHS and HRSA-funded
clinics should be staffed and equipped to do occupational health assessments.
As for communication strategies, there is a need for publicizing more effectively such
success stories as the beneficial impact of regulations and guidelines on occupational
safety and health. Finally, joint partnership opportunities with State, Tribal and local
governmental entities, private sector businesses, unions and medical professionals should
be identified for information sharing and dissemination.
Public Health Service Agencies
Agency for Healthcare Research and Quality (AHRQ)
Agency for Toxic Substances and Disease Registry
Centers for Disease Control and Prevention
Food and Drug Administration
Health Resources and Service Administration
Indian Health Service
National Institutes of Health
Substance Abuse and Mental Health Services Administration
Office of the Surgeon General
Healthy People 2000 Coordinator
Office of Disease Prevention and Health Promotion
Humphrey Building, Room 738G
200 Independence Avenue SW.
Washington, DC 20201
202-205-8611
Fax: 202-690-7054
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