Getting home safe and sound: occupational safety and health administration at 38

Working With the Strategy Master-Dr Michael Silverstein MD, MPH [1945-2024]

New Solutions offers a short memorial statement noting the January 2, 2024, death of Dr Michael Silverstein, an internationally known leader in the field of occupational health and safety. Dr Silverstein spent 53 years specializing in the fields of occupational medicine, public health, and general preventive medicine. He was the Assistant Director for Occupational Health and Safety with the United Automobile Workers Union for 15 years. He served as the Director of Policy for the U.S. Occupational Safety and Health Administration (OSHA) during the Clinton Administration. He later served as Director of the Washington State OSHA program for 10 years and was the Assistant Director for Industrial Safety and Health in the Washington State Department of Labor and Industries. A long-time friend of New Solutions, Dr Silverstein was the journal's first Scientific Solutions editor.

Occupational Health and Safety Statistics as an Indicator of Worker Physical Health in South African Industry

Operations in general industry, including manufacturing, expose employees to a myriad of occupational health hazards. To prevent exposure, occupational health and safety regulations were enacted, with both employers and workers instituting various risk reduction measures. The analysis of available occupational disease and injury statistics (indicators of worker physical health) can be used to infer the effectiveness of risk reduction measures and regulations in preventing exposure. Thus, using the READ approach, analyses of occupational disease and injury statistics from South African industry, derived from annual reports of the Compensation Fund, were conducted. The publicly available database of occupational disease and injury statistics from the South African general industry is unstructured, and the data are inconsistently reported. This data scarcity, symptomatic of an absence of a functional occupational disease surveillance system, complicates judgement making regarding the effectiveness of implemented risk reduction measures, enacted occupational health and safety regulations and the status of worker physical health from exposure to workplace hazards. The statistics, where available, indicate that workers continue to be exposed to occupational health impacts within general industry, notwithstanding risk reduction measures and enacted regulations. In particular, worker physical health continues to be impacted by occupational injuries and noise-induced hearing loss. This is suggestive of shortcomings and inefficiencies in industry-implemented preventive measures and the regulatory state. A robust national occupational disease surveillance system is a regulatory tool that should detect and direct policy responses to identified occupational health hazards.

Falling Short: The State's Role in Workplace Safety and Health

The state plays a major role in occupational safety and health in the United States, impacting all aspects including resources, training, research, standard setting, and enforcement. Howard Waitzkin has challenged public health activists to rethink their understanding of the State and to replace the dominant pluralist view with a conception that serves as the theory for more effective public health action to improve the health of working people. This paper is a response to Waitzkin’s challenge utilizing a framework that views the State as a reflection of the relationship and power dynamics between capital and labor, within the confines of institutions, policies, and laws organized to protect and maintain the capitalist system. A historical review of safety and health since the Occupational Safety and Health Act of 1970 in the context of the capitalist state serves as the basis for suggestions as to how this might shape safety and health advocates’ strategy.

Lost in translation: The challenge of adapting integrated approaches for worker health and safety for low- and middle-income countries

OBJECTIVES

To describe the process of adapting an intervention integrating occupational safety and health (OSH) and health promotion for manufacturing worksites in India and the challenges faced in implementing it; and explore how globalization trends may influence the implementation of these integrated approaches in India and other low- and middle-income countries (LMICs).

METHODS

This study-conducted in 22 manufacturing worksites in Mumbai, India-adapted and implemented an evidence-based intervention tested in the U.S. that integrated OSH and tobacco control. The systematic adaptation process included formative research and pilot testing, to ensure that the tested intervention was tailored to the local setting. We used qualitative methods and process evaluation to assess the extent to which this intervention was implemented, and to explore barriers to implementation.

RESULTS

While participating worksites agreed to implement this intervention, not all components of the adapted intervention were implemented fully in the 10 worksites assigned to the intervention condition. We found that the OSH infrastructure in India focused predominantly on regulatory compliance, medical screening (secondary prevention) and the treatment of injuries. We observed generally low levels of leadership support and commitment to OSH, evidenced by minimal management participation in the intervention, reluctance to discuss OSH issues with the study team or workers, and little receptivity to recommendations resulting from the industrial hygienist's reports.

CONCLUSION

India presents one example of a LMIC with a rising burden of non-communicable diseases and intensified exposures to both physical and organizational hazards on the job. Our experiences highlight the importance of national and global trends that shape workers' experiences on the job and their related health outcomes. Beyond a singular focus on prevention of non-communicable diseases, coordinated national and international efforts are needed to address worker health outcomes in the context of the conditions of work that clearly shape them.

Healthy and productive workers: using intervention mapping to design a workplace health promotion and wellness program to improve presenteeism

Background

Presenteeism is a growing problem in developed countries mostly due to an aging workforce. The economic costs related to presenteeism exceed those of absenteeism and employer health costs. Employers are implementing workplace health promotion and wellness programs to improve health among workers and reduce presenteeism. How best to design, integrate and deliver these programs are unknown. The main purpose of this study was to use an intervention mapping approach to develop a workplace health promotion and wellness program aimed at reducing presenteeism.

Methods

We partnered with a large international financial services company and used a qualitative synthesis based on an intervention mapping methodology. Evidence from systematic reviews and key articles on reducing presenteeism and implementing health promotion programs was combined with theoretical models for changing behavior and stakeholder experience. This was then systematically operationalized into a program using discussion groups and consensus among experts and stakeholders.

Results

The top health problem impacting our workplace partner was mental health. Depression and stress were the first and second highest cause of productivity loss respectively. A multi-pronged program with detailed action steps was developed and directed at key stakeholders and health conditions. For mental health, regular sharing focus groups, social networking, monthly personal stories from leadership using webinars and multi-media communications, expert-led workshops, lunch and learn sessions and manager and employee training were part of a comprehensive program. Comprehensive, specific and multi-pronged strategies were developed and aimed at encouraging healthy behaviours that impact presenteeism such as regular exercise, proper nutrition, adequate sleep, smoking cessation, socialization and work-life balance. Limitations of the intervention mapping process included high resource and time requirements, the lack of external input and viewpoints skewed towards middle and upper management, and using secondary workplace data of unknown validity and reliability.

Conclusions

In general, intervention mapping was a useful method to develop a workplace health promotion and wellness program aimed at reducing presenteeism. The methodology provided a step-by-step process to unravel a complex problem. The process compelled participants to think critically, collaboratively and in nontraditional ways.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3843-x) contains supplementary material, which is available to authorized users.

Organizational Characteristics Influence Implementation of Worksite Health Protection and Promotion Programs: Evidence From Smaller Businesses

OBJECTIVE

We explored associations between organizational factors (size, sector, leadership support, and organizational capacity) and implementation of occupational safety and health (OSH) and worksite health promotion (WHP) programs in smaller businesses.

METHODS

We conducted a web-based survey of human resource managers of 117 smaller businesses (<750 employees) and analyzed factors associated with implementation of OSH and WHP among these sites using multivariate analyses.

RESULTS

Implementation of OSH, but not WHP activities, was related to industry sector (P = 0.003). Leadership support was positively associated with OSH activities (P < 0.001), but negatively associated with WHP implementation. Organizational capacity (budgets, staffing, and committee involvement) was associated with implementation of both OSH and WHP. Size was related to neither.

CONCLUSIONS

Leadership support and specifically allocated resources reflecting that support are important factors for implementing OSH and WHP in smaller organizations.

Worker Engagement in the Health and Safety Regulatory Arena under Changing Models of Worker Representation

This paper examines the efforts of a labor-community-university partnership in Southern California to confront violations of workplace health and safety standards by employers of nonunion workers in low-wage jobs. A worker engagement model has opened avenues for workers and worker advocates to participate in the regulatory arena absent union representation. This approach has achieved notable successes to date, including groundbreaking Cal/OSHA citations and nascent collaboration with agency officials to target enforcement of health and safety standards. We argue this model constitutes the foundation needed to support a potentially viable form of tripartism that allows nonunion workers a voice, albeit limited, in the health and safety regulatory process.

Effects of social, economic, and labor policies on occupational health disparities

BACKGROUND

This article introduces some key labor, economic, and social policies that historically and currently impact occupational health disparities in the United States.

METHODS

We conducted a broad review of the peer-reviewed and gray literature on the effects of social, economic, and labor policies on occupational health disparities.

RESULTS

Many populations such as tipped workers, public employees, immigrant workers, and misclassified workers are not protected by current laws and policies, including worker's compensation or Occupational Safety and Health Administration enforcement of standards. Local and state initiatives, such as living wage laws and community benefit agreements, as well as multiagency law enforcement contribute to reducing occupational health disparities.

CONCLUSIONS

There is a need to build coalitions and collaborations to command the resources necessary to identify, and then reduce and eliminate occupational disparities by establishing healthy, safe, and just work for all.

Integration of health protection and health promotion: rationale, indicators, and metrics

OBJECTIVE

To offer a definition of an "integrated" approach to worker health and operationalize this definition using indicators of the extent to which integrated efforts are implemented in an organization.

METHODS

Guided by the question-How will we know it when we see it?-we reviewed relevant literature to identify available definitions and metrics, and used a modified Delphi process to review and refine indicators and measures of integrated approaches.

RESULTS

A definition of integrated approaches to worker health is proposed and accompanied by indicators and measures that may be used by researchers, employers, and workers.

CONCLUSIONS

A shared understanding of what is meant by integrated approaches to protect and promote worker health has the potential to improve dialogue among researchers and facilitate the research-to-practice process.

The impact of regulatory enforcement and consultation visits on workers' compensation claims incidence rates and costs, 1999-2008

BACKGROUND

Studies of regulatory effectiveness have shown mixed evidence of impact of inspections on injury rates. We examine changes in workers compensation claims rates and costs for Washington employers having either an inspection, with or without citation, or a voluntary consultation activity.

METHOD

We merge 10 years of enforcement and consultation activity with workers compensation records at the individual workplace level for stable firms with a single business location and at least 10 full-time employees. The change in claims incidence rates (CIRs) was estimated, controlling for workplace claims rate history, size, and industry. Separate analyses were performed for non-musculoskeletal and musculoskeletal (MSD) CIRs, claims costs and for enforcement activities with citation and without citation.

RESULTS

Enforcement activities are associated with a significant reduction in CIRs and costs. Similar results may also be attributable to consultations. Inspections were associated with a 4% decline in time-loss claims rates relative to uninspected workplaces. The effect strengthens when MSD claims are excluded. Citations for non-compliance are associated with a 20% decline in non-MSD CIRs relative to uninspected workplaces. There is also some evidence for a reduction in MSD claims rates beginning in the second year following inspection. Enforcement and consultation activity is associated with substantial decreases in claims costs.

CONCLUSIONS

Enforcement activities make a significant contribution to reducing CIRs and costs. Similar results following consultations may also exist. Inspections with citations are more effective than those without. Claims rates for non-MSD injuries, related to hazards covered by specific standards, are more affected in the year following the visit, while those for MSDs take longer to begin falling.

Preventing chronic disease in the workplace: a workshop report and recommendations

Chronic disease is the leading cause of death in the United States. Risk factors and work conditions can be addressed through health promotion aimed at improving individual health behaviors; health protection, including occupational safety and health interventions; and efforts to support the work-family interface. Responding to the need to address chronic disease at worksites, the National Institutes of Health and the Centers for Disease Control and Prevention convened a workshop to identify research priorities to advance knowledge and implementation of effective strategies to reduce chronic disease risk. Workshop participants outlined a conceptual framework and corresponding research agenda to address chronic disease prevention by integrating health promotion and health protection in the workplace.

An impact evaluation of a federal mine safety training regulation on injury rates among US stone, sand, and gravel mine workers: an interrupted time-series analysis

OBJECTIVES

We evaluated the impact of a safety training regulation, implemented by the US Department of Labor's Mine Safety and Health Administration (MSHA) in 1999, on injury rates at stone, sand, and gravel mining operations.

METHODS

We applied a time-series design and analyses with quarterly counts of nonfatal injuries and employment hours from 7998 surface aggregate mines from 1995 through 2006. Covariates included standard industrial classification codes, ownership, and injury severity.

RESULTS

Overall crude rates of injuries declined over the 12-year period. Reductions in incident rates for medical treatment only, restricted duty, and lost-time injuries were consistent with temporal trends and provided no evidence of an intervention effect attributable to the MSHA regulation. Rates of permanently disabling injuries (PDIs) declined markedly. Regression analyses documented a statistically significant reduction in the risk rate in the postintervention time period (risk rate = 0.591; 95% confidence interval = 0.529, 0.661).

CONCLUSIONS

Although a causal relationship between the regulatory intervention and the decline in the rate of PDIs is plausible, inconsistency in the results with the other injury-severity categories preclude attributing the observed outcome to the MSHA regulation. Further analyses of these data are needed.

Health disparities in the Latino population

In this review, the authors provide an approach to the study of health disparities in the US Latino population and evaluate the evidence, using mortality rates for discrete medical conditions and the total US population as a standard for comparison. They examine the demographic structure of the Latino population and how nativity, age, income, and education are related to observed patterns of health and mortality. A key issue discussed is how to interpret the superior mortality indices of Latino immigrants and the subsequent declining health status of later generations. Explanations for differences in mortality include selection, reverse selection, death record inconsistencies, inequalities in health status, transnational migration, social marginality, and adaptation to environmental conditions in the United States. The utility of the public health social inequality framework and the status syndrome for explaining Latino disparities is discussed. The authors examine excess mortality from 8 causes: diabetes, stomach cancer, liver cancer, cervical cancer, human immunodeficiency virus/acquired immunodeficiency syndrome, liver disease, homicide, and work-related injuries. The impact of intergenerational changes in health behavior within the Latino population and the contributory role of suboptimal health care are interpreted in the context of implications for future research, public health programs, and policies.