Occupational Health
16 deaths per day:
http://www.youtube.com/watch?v=pssw5bnjnr4
Matewan (union meeting):
http://www.youtube.com/watch?v=qwEMIvDEFy4
Young Worker injury:
http://www2.worksafebc.com/Publications/Multimedia/Vide
os.asp?ReportID=34939
Triangle Shirtwaist Fire: The Race to the Bottom:
http://www.usw.org/media_center/news_articles?id=0739
Introduction
• Occupational disease: any abnormal
condition or disorder, other than one caused
by occupational injury, caused by workrelated factors.
• Occupational injury: injury resulting from
exposure resulting from a single incident in
the work environment.
Scope of the Problem: Global
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2.6 billion workers
250 million occupational injuries/year
330,000 fatalities
1.1 million worker deaths each year from
work-related illnesses
• 160 million new cases of diseases resulting
from the worker’s environment
Scope of the Problem: U.S.
• 14 people die of work-related injuries each day in
the U.S. About 5000 people/yr.
• Fatalities have declined significantly over past 100
years: 23,000 (1913); 14,000 (1968); 4,600
(2010).
• Economic impact of occupational injuries,
illnesses, and deaths: $142 billion in 2006.
• Importance of occupational safety and health to
the community  safety and health of
surrounding community is closely linked to
workplace safety and health.
History of Occupational Safety and
Health Problems
• 1561: De Re Metallica (G. Agricola) – mining
hazards, need for ventilation)
• 1700: Discourse on Diseases of Workers (Ramazzini)
• Industrial Revolution
• State legislation
– Child labor laws
– Workers’ compensation laws
• Federal legislation
– Bureau of Labor (1884)
– Many related laws from 1908 to 1970
– Occupational Safety and Health Act of 1970
Highlights of Federal Occupational
Safety and Health Legislation
Year Legislation
1908
1916
1926
1927
Federal Workmen’s Compensation Act (limited coverage)
Federal Highway Aid Act
Federal Workmen’s Compensation Act (included workers)
Federal Longshoremen’s & Harbor Workers’ Compensation
1936
1952
1959
1960
1966
Walsh-Healey Public Contracts Act
Coal Mine Safety Act
Radiation Standards Act
Federal Hazardous Substances Labeling Act
National Traffic & Motor Vehicle Safety Act
Child Protection Act (banned hazardous household substances)
National Commission on Product Safety created
Natural Gas Pipeline Safety Act
Construction Safety Act
Coal Mine Health & Safety Act
Occupational Safety & Health Act
Worker Right to Know Act (part of SARA, Superfund II)
Act
1967
1968
1969
1970
1986
Industrial Revolution
• Serious environmental and workplace
health/safety problems.
• Govt. and industry did little.
• Earliest unions take on H & S issues
– (e.g. Knights of Labor, Industrial Workers of World)
take on H & S.
• Struggles over community and worker health 
started first in community, led by activists with
access to legal and scientific assistance.
Progressive Era (1890-1920)
• Community/worker health struggles.
– Started in communities, led by activists linking to legal,
scientific assistance. Mining, textile mills, foundries
• Alice Hamilton (1869-1970)
– Health researcher, came out of settlement movement
(middle/upper class women, promoted better housing,
sanitation, public health)
• Workers Health Bureau (1920s)
– Organized by women activists to promote worker
health and safety
“Those who know don’t tell” (film
about worker health and safety)
• Why do companies hide the truth? (about cause of
worker death/injury, information/knowledge about
chemicals, etc.)
– It’s cheaper not to tell. Workers are too fearful to
protest. It would damage company reputation.
• Instead, companies push the cost of health onto
society  they externalize the cost to the workers
and society.
“Those who know don’t tell” (film
about worker health and safety)
• In late 19th century/early 20th century, workers were getting
sick and dying. Govt. did nothing. Workers protested.
• Employers take safety short-cuts. e.g. boss turns off air
monitor alarm in microchip plant, so that workers will
continue working.
• Not enough safety focus in workplaces.
• Hawk’s Nest/Gauley Bridge disaster (1931-32): workers
dropped dead of acute silica inhalation.
• Workers rely on themselves to monitor air and their health.
• Alice Hamilton was early health and safety crusader.
“Those who know don’t tell” (film
about worker health and safety)
• When a worker died, the company would typically hide the cause of
death.
• Workers join together to change things: unions, workers, community,
public health activists.
• “Mules got treated better than workers.”
• Established unions (United Mineworkers, Steelworkers, Chemical
Workers) gained control of hazards, pushed for better conditions.
• Accident prevention can happen with a more educated staff, including
production workers.
• Occupational health doctors advanced in 1970s, as some unions (Oil,
Chemical and Atomic Workers, United Steelworkers) trained them.
“Matewan” (film by John Sayles, 1988)
• Coal mine conflict (Coal Wars), 1920-21, West
Virginia.
• Companies, together with government, sought to
break the unions and their organizing efforts.
• Joe is a union organizer, trying to unite local
whites, African-Americans, Italian immigrant
workers.
• Joe tries to help workers see their class interests
(the workers work, management doesn’t).
• Formation of class consciousness that will help
workers and the union to overcome the company’s
efforts to divide and conquer the workers.
Solidarity
• Both “Those who know don’t tell” and
“Matewan” demonstrate that “an injury to
one is an injury to all.”  the basic message
of the labor movement and the worker
health and safety movement in the U.S.
• “An injury to one is an injury to all” =
solidarity on part of workers and
communities for one another.
Alice Hamilton, workplace health researcher
Resurgence of Health and Safety
Reform/Activism (1950s-60s)
• Irving Selikoff – medical research on asbestos
hazards.
• Mining hazards, accidents, illnesses.
• Haphazard state regulations.
• 14,000 deaths/year.
• 1960s social movement era (civil rights,
environmentalism) – pushed along H & S reforms.
• Union leadership on H & S reform 
– Oil, Chemical & Atomic Workers, United Auto Workers
Irving
Selikoff, MD,
workplace
health
researcher
Irving Selikoff
• Addressed the cover-up by the asbestos
industry of the long-known hazards of
asbestos for workers.
• Worked closely with labor unions.
• Helped to develop occupation health clinics.
Tony Mazzocchi,
labor activist,
Oil, Chemical &
Atomic Workers
Tony Mazzocchi
• Built coalitions with scientists, public health
advocates, environmentalists in 1950s against
atmospheric atomic bomb testing.
• Powered the 1960s movement of
labor/environment/public health for passage of the
OSH Act (1970) and creation of OSHA.
• Created training program for doctors to become
occupational health physicians, bringing together
medical doctors and labor.
• Forged labor/environmental coalitions throughout the
1970s, 80s, 90s.
Occupational Safety & Health Act of
1970
• Purpose: to ensure that employers in the private sector
provide employees with a working environment free of
recognized hazards that can cause death or serious harm.
Creates the “General Duty Clause”:
– The employer must provide a work environment free of
recognized hazards  that is, the employer must
provide a safe workplace. The employer is ultimately
responsible for providing a safe workplace.
– Employees must work safely.
• Formed Occupational Safety & Health Administration
(OSHA): to create & enforce occupational standards
• Formed National Institute for Occupational Safety & Health
(NIOSH): research body now in CDC; recommends
standards
Karen Silkwood, Oil, Chemical and
Atomic Workers
Karen Silkwood
• Whistleblower about sloppy conditions at a KerrMcGee nuclear facility in Oklahoma.
• Killed before she could reveal information about
corporate deception and health and safety
shoddiness to a New York Times reporter (1974).
• Her struggle and death demonstrates power of
corporations to silence whistleblowers and avoid
accountability.
• An unsung hero for standing up for health and
safety.
Key Worker Health and Safety Rights
1. Right to work in a workplace free of recognized
hazards. The OSHA General Duty Clause:
employer must provide a workplace free of
recognized hazards.
2. Right to refuse hazardous work.
3. Right to not be discriminated against for
exercising health and safety rights (e.g. filing a
complaint).
4. Right to know about health and safety hazards
you are working with.
5. Right to health and safety training.
Hierarchy of Controls,
Workplace health and safety
1. Eliminate/reduce the hazard (e.g. substitute a
safer chemical)
2. Engineering controls (e.g. use ventilation to
remove the hazard)
3. Administrative controls (e.g. work practices
such shifts or rotations to reduce exposures to
hazards)
4. Personal Protective Equipment (e.g. respirators,
suits and gloves)
Recent Trends in Workplace injuries
and illnesses
• Decline in number of injuries and illnesses
reported in private industry since 1992.
• Goods-producing industries have higher rate of
non-fatal injury than service-producing.
– Highest: agriculture, forestry, fishing, hunting.
– Highest service-producing: education, health
care.
Injuries/fatalities in workplace
• Fatalities: 5,214 fatalities (2008)
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#1 cause: transportation
#2 cause: struck-by object, caught-in/between
#3 cause: assaults, violent attacks
#4 cause: falls
Most homicides  robbery motivated
• Types of injuries:
– Motor vehicle crashes, machinery injuries,
assaults, falls, electrical injuries
– Leading anatomical site: hands and fingers.
Fatal Work-Related Injuries
• Highway incidents leading cause
– Falls, being struck by object, homicide
• Industries with highest rates of fatal
occupational injuries
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Agriculture
Forestry
Fishing and hunting
Mining
Transportation and warehousing
Manner of Fatal Work Injuries, 2008
Nonfatal Workplace Injury and Illness
Incidence Rates by Industry, 2008
Nonfatal Work-Related Injuries
• Males account for majority of treatment
• Younger workers highest nonfatal
workplace injury/illness rate
• Disabling injuries and illnesses
– Repeat trauma disorders
Characteristics of Workers Involved in
Work-Related Injuries
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Age
Gender
Poverty and race
Geographic differences in workplace
injuries
• Temporal variations in workplace injuries
• Workplace injuries by industry and
occupation
Workplace injuries by age
• younger workers (<25)  higher rates than
older workers
• injury death rates highest in oldest workers
(>65)
• 100,000 children (many employed illegally)
injured each year.
Unintentional Injuries in the Workplace
Number and rate of fatal occupational injuries by
age of worker, 2002.
© Data from U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute
for Occupational Safety and Health.
Hours Worked and Fatal Work
Injuries by Gender, 2008
Most Dangerous Jobs in 2008
Workplace injuries by gender
• Males injured more than females, every age.
• Men more likely fatally injured than
women.
• Homicides  half of women’s work-related
deaths
Workplace injuries by income
and race
• Lower socioeconomic groups  higher
death rates
• Injury death rates 12% higher for nonwhites than whites.
• Highest death rates: Native Americans.
• Asian Americans: low injury death rates.
Workplace injuries by geography
• Highest injury death rates in mountain
states (Wyoming) and Alaska
• Highest farm machinery injuries in North
Central states.
Workplace injuries by industry,
occupation
• Highest fatality rates: mining, fishing,
agriculture, construction, transportation
• Most dangerous blue collar jobs: timber
workers, crab fishermen
Workplace Unintentional Injuries:
Prevention and Control
1.
2.
3.
4.
Eliminating or modifying the job
Changing the work environment
Making machinery safer
Improving the selection, training, and
education of workers
Workplace Violence
• Homicides are 3rd leading cause of death after
motor vehicle crashes.
• Homicides are 2nd leading cause of death among
women workers.
• Most workplace homicides (85%) are robberyrelated.
• Hospitals, nursing homes, social service agencies
are prone to non-fatal assaults.
• Risk factors: working near money/valuables,
working alone, working late at night.
• Prevention: change environmental design, work
policy, worker behavior.
Occupational Diseases
• 430,000 cases reported each year.
• #1: Chronic musculoskeletal diseases
(trauma to muscles, joints, tendons).
Leading cause of workplace disability.
Most costly.
• #2: Dermatological conditions. Contact
dermatitis, skin cancer, infections.
• #3: Occupational lung diseases. Inhalation
of toxic substances.
Occupational lung diseases
• Long latency period
• Pneumoconiosis: fibriotic lung disease
caused by inhalation of dusts:
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Asbestosis: 1,265 die each year.
Black lung (coal dust) disease (54%)
Silicosis (crystalline silica), 15%.
Byssinosis (brown lung disease), cotton dust,
20 deaths.
Other occupational diseases
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Neurological disorders
Reproductive disorders
Cardiovascular disorders
Cancer deaths, from workplace exposures
Bloodborne pathogens (big concern for
health care workers)
Controlling occupational diseases
• Vigilance of employer, employee,
government is essential.
• Specific controls needed to control disease.
• Occupational disease control programs
require trained personnel
Resources for Prevention of
workplace injuries and diseases
• Safety and health professionals
– Safety engineers and safety professionals 
education, correct and remove hazards
– Health physicists  monitor radiation
– Industrial hygienists examine workplace
environmental factors
– Occupational physicians  preventive
medicine.
– Occupational health nurses
Resources for Prevention of
workplace injuries and diseases
• Safety and health programs: hire and maintain
healthy workers.
• Pre-placement exams.
• Disease prevention programs: control diseases.
• Safety programs: reduce injuries.
• Health promotion programs: boost morale and
productivity, reduce medical costs.
• Employee Assistance Programs: assist employees
in overcoming personal problems.
Prevention and Control of
Occupational Diseases and Disorders
• Agent-hostenvironment model
Host
– Identification and
evaluation of agents
– Procedures
– Engineering controls
– Protective devices
– Surveillance
Agent
Environment
MassCOSH volunteer testifying at a hearing
calling for a better teen labor law
Social Movements Create Change
• Labor movement and urban reform movements 
raised awareness and built pressure for better
health and safety conditions at work, Progressive
Era and later too.
• 1960s social movements created a dynamic to
push through changes in health and safety laws:
federal OSH Act, Mining Safety Act (MSH Act).
• Social movements respond to disasters (mines,
plant explosions, fires)  push through new laws.
Social Movements Create Change
• Health and safety heroes: Alice Hamilton, Tony
Mazzocchi, Irving Selikoff. Coalition builders
between unions and public health.
• Environmental/workplace health and safety
coalitions are important for change, forcing new
regulations, enforcement. e.g. Workers Health
Bureau (1920s), OSH Act coalition (late 1960s),
right-to-know movement (1980s).
Social Movements Create Change
• Worker and Community Right-to-Know Acts (part
of SARA (Superfund part 2, 1986)  resulted
from broad activism by labor and environmental
activists.
• Social movements pushed Congress to act  they
force regulations into being.
• Tragedies/disasters help spur action, e.g. Bhopal
chemical release (1984); Farmington, WV mine
disaster (1968); Sago mine disaster (2006),
Triangle Shirtwaist Co. fire (1911). But some
tragedies are quickly forgotten (e.g. Hawk’s Nest)
Weakness of Social Movements
• Labor union membership has been in decline since
1960: 32% (1960) to 12% (2010), percent of
workforce in unions.
• While Labor is vocal, it has lost overall political
clout.
• The environmental movement is weak and
fragmented, much weaker than when it
successfully pushed through SARA and
Community Right-to-Know (1986).
Failure of Regulation
• Backlash of industry against OSHA regulation
since 1970s.
• OSHA’s power and effectiveness undermined by a
small budget (smaller than U.S. Fish and Wildlife
Service).
• Up to 2008, only 1500 OSHA inspectors
nationwide (Spain has 1500, but 1/6 of the
population)  can’t do an effective job of
enforcing regulations. OSHA under Pres. Obama
raised OSHA inspectors to about 2,400.
Failure of Regulation
• Industry and Republican administrations, since
1980, have forced OSHA to move away from
enforcement of regulations toward voluntary
compliance with regulations.
• Industry is powerful and will fight back: e.g.
ergonomics standard; asbestos research by Dr.
Irving Selikoff.
• A long, hard effort (10 years) to establish an
OSHA ergonomics standard (to combat repetitive
stress injuries) finally succeeded in 2000 (under
Clinton), only to be thrown out in early 2001 by
President Bush.
Summary
• Overall improvement in workplace health and
safety in U.S. since 1960s, since OSHA Act was
passed.
• But passage of new regulations and enforcement
of many current regulations are thwarted,
undermined by powerful industry elites and their
allies in federal government.
• The real cost of health and safety (illness, injury,
fatalities) has been shifted (“externalized”) onto
workers, their families and communities.
Summary
• Backlash on workplace health and safety, and
environmental activism.
• Worker and Community Right-to-Know Acts
(1986), part of SARA law, were the last
substantial health and safety and environmental
legislation in U.S.  the power of capital (owners
of means of production) has held labor and
environmentalism in check.