The changing organization of work and the safety and health of working people: a commentary

Recent trends in the organization of work may affect worker health through a variety of pathways--by increasing the risk of stress-related illnesses, such as cardiovascular disease, musculoskeletal disorders, and psychological disorders, by increasing exposure to hazardous substances and violence on the job, or by affecting occupational health services and training programs. Much remains to be learned about the nature of changes in work organization, and how they affect worker health and safety. While available evidence is limited, such evidence suggests that recent trends in work organization may be increasing the risk of occupational illnesses. In a groundbreaking publication, the National Institute for Occupational Safety and Health has provided a concise summary of available knowledge and a detailed agenda for research and development.     

Narratives of risk in occupational health and safety: why the 'good' boss blames his tradesman and the 'good' tradesman blames his tools

Abstract: Risk and its control are important themes in occupational health and safety. In the current regulatory framework, risk is conceptualised as a probabilistic expression of hazard potential. However, social meanings of risk in the workplace may be different. The social context of work shapes the ways that risk is understood in the workplace, yet little research in occupational health and safety acknowledges it. A few studies of risk have used qualitative research methods to elicit understandings of risk at work; however, little research explores the experiences of both employers and employees. This study describes the narratives of risk in occupational health and safety of employers and employees in the Victorian painting industry. Using ethnographic methods, we collected data about the contexts in which risk is experienced and the sources of risk that each group identifies. These narratives reveal that risk in the painting industry is constructed through the interactions of three factors: the social context, the hierarchical structure of the industry and the shared assumptions about risk control through individual skills and responsibilities. The narratives explain why occupational health and safety strategies focusing solely on individual behaviour change or technical measures will be unsuccessful.     

Social context for workplace health promotion: feasibility considerations in Costa Rica,Finland, Germany,Spain and Sweden

We constructed a simple, flexible procedure that facilitates the pre-assessment of feasibility of workplace health promotion (WHP) programmes. It evaluates cancer hazards, workers' need for hazard reduction, acceptability of WHP, and social context. It was tested and applied in 16 workplace communities and among 1085 employees in industry, construction, transport, services, teaching and municipal works in Costa Rica, Finland, Germany, Spain and Sweden. Social context is inseparable from WHP. It covers workers' organizations and representatives, management, safety committees, occupational health services, health and safety enforcement agencies, general health services, non-government organizations, insurance systems, academic and other institutions, regulatory stipulations pertaining WHP, and material resources. Priorities, risk definitions, attitudes, hazard profiles, motivations and assessment methods were highly contextual. Management preferred passive interventions, helping cover expert costs, participating in planning and granting time. Trade unions, workers' representatives, safety committees and occupational health services appeared to be important operational partners. Occupational health services may however be loaded with curative and screening functions or be non-existent. We advocate participatory, multifaceted WHP based on the needs and empowerment of the workers themselves, integrating occupational and lifestyle hazards. Workforce in irregular and shift work, in agriculture, in small enterprises, in the informal sector, and immigrant, seasonal and temporary workers represent groups in need of particular strategies such as community health promotion. In a more general framework, social context itself may become a target for intervention.     

A pilot study of occupational injury and illness experienced by classical musicians

Limited attention is paid to the hazards experienced by orchestra musicians in the occupational health and safety literature. Within that literature, the primary focus has been on noise exposure. A focus on this area is warranted because high sound pressure levels are a product of this work environment. However, in addition to being at risk for noise-induced hearing loss, workers are also at risk for musculoskeletal injury and illness related to stressful body postures held for prolonged work periods. The socio-political forces of employment may place workers at risk for mental health disorders (e.g., depression). The researchers distributed an anonymous survey to classical orchestra musicians in the southwestern United States. The survey inventoried several areas related to occupational health risks. Results suggest low health care-seeking behaviors relative to self-reported signs and symptoms of morbidity. Musicians also reported limited formal training and education regarding occupational health risks. Risk information was provided late in their professional development. This is a particular concern because of the young age at which music training is initiated.     

Health Indicators of a Cohort of Midwest Farmers: Health Outcomes of Participants in the Certified Safe Farm Program

Occupational illness, injury, and fatality rates for those working in production agriculture are higher than in any other industry. A potential risk factor contributing to occupational injuries across all industries is acute or chronic co-morbidity (e.g., obesity, high blood pressure, high cholesterol), and related health issues that increase the risk for an occupational injury or illness. These chronic health conditions have been associated not only with increased risk for injuries, but also higher health-care costs, and greater absenteeism. Certified Safe Farm (CSF) is a comprehensive intervention program aimed to reduce occupational health and safety hazards and to promote general health among farmers. Prior publications have described CSF program efforts to reduce hazardous exposures, disabling injuries, organic dust toxic syndrome, occupational health-care costs, and to increase positive occupational health behaviors. This paper reports on the general health indicators of a cohort of 438 Iowa farm owner/operators enrolled in the CSF program. Overall, this study found that the farming population in Iowa has higher body mass index (BMI), but lower total cholesterol, low-density lipoprotein (LDL), and lower prevalence of hypertension compared to the general population. There was evidence that the combination of high blood pressure, cholesterol, and BMI were related to increased injury rates. Poor self-reported health status was also related to increased injuries but was not related to clinical health indicators. The CSF intervention led to improvements on health outcomes, particularly among those in the 35 to 49 age group. Little research has focused on the individual’s general health status as a predictor of risk of occupational injury. This study suggests the need for additional research and interventions integrating occupational safety and health prevention along with health promotion.     

The occupational physician and chemical disasters: old problem, new threats

Chemical disasters continue to occur, in spite of significant progress in process engineering, industrial hygiene practices, and improved enforcement of health and safety legislation. In addition to the ever-present risk of unintentional incidents, recent geopolitical events have raised the specter of chemical terrorism. Terrorists or even disgruntled employees may exploit lapses in chemical plant security and ready access to large quantities commodity chemicals, capable of causing great harm to the population if suddenly and unexpectedly released. Occupational physicians, who are uniquely equipped to understand the health hazards associated with industrial chemicals should be involved in prevention of planning for, and response to chemical disasters. Measures for improving preparedness include training and collaboration, not only with plant health and safety personnel but also with public safety and health care providers, through drills and assessment of needs and capacities. Occupational physicians should be aware that communications and other systems often fail in disasters, requiring multiple alternatives. Likewise, occupational health specialists should be prepared to deal with mass casualties, including psychological casualties which may be difficult to distinguish from those of organic etiology. Chemical disaster preparedness is an urgent and demanding responsibility for occupational physicians everywhere.     

An occupational health and safety intervention research agenda for production agriculture: Does safety education work?

It is clear that agriculture has not kept pace with other hazardous industries in reducing its injury rate. For example, between 1960 and 1990 the work death rate for agriculture decreased only 28% while the work death rates decreased 65% for mining and 55% for construction [Purschwitz (1992)]. A national conference in Iowa in 1988 came to the forceful conclusion that “America's most productive workforce was being systematically liquidated by an epidemic of occupational disease and traumatic death and injury” [NCASH (1988)]. In 1991, the nation's top public health officer, the U.S. Surgeon General, convened a conference titled “FarmSafe 2000—A National Coalition for Local Action,” to formally address agricultural safety and health issues. Importantly, conferees recognized that preventing injury and disease was superior to trying to rehabilitate people after an injury occurred. But does participation in farm safety and health educational programs lead to a reduction in risk of injury from farm work? Questions are being raised about the value of farm safety and health educational information, campaigns, programs, and related activities. The questions have identified a critical gap in the literature of farm safety and health education. There is currently no good evidence demonstrating that farm safety and health education, campaigns, programs, or related activities lead to a relatively stable reduction of risk on the farm. In other words, do farmers and their families actually put to use, in a relatively permanent or stable manner, the educational information regarding elimination, reduction, or control of physical hazards and the modification of work behavior that may cause injury? © 1996 Wiley-Liss, Inc.     

Global Estimates of the Burden of Injury and Illness at Work in 2012

This article reviews the present indicators, trends, and recent solutions and strategies to tackle major global and country problems in safety and health at work. The article is based on the Yant Award Lecture of the American Industrial Hygiene Association (AIHA) at its 2013 Congress. We reviewed employment figures, mortality rates, occupational burden of disease and injuries, reported accidents, surveys on self-reported occupational illnesses and injuries, attributable fractions, national economic cost estimates of work-related injuries and ill health, and the most recent information on the problems from published papers, documents, and electronic data sources of international and regional organizations, in particular the International Labor Organization (ILO), World Health Organization (WHO), and European Union (EU), institutions, agencies, and public websites. We identified and analyzed successful solutions, programs, and strategies to reduce the work-related negative outcomes at various levels. Work-related illnesses that have a long latency period and are linked to ageing are clearly on the increase, while the number of occupational injuries has gone down in industrialized countries thanks to both better prevention and structural changes. We have estimated that globally there are 2.3 million deaths annually for reasons attributed to work. The biggest component is linked to work-related diseases, 2.0 million, and 0.3 million linked to occupational injuries. However, the division of these two factors varies depending on the level of development. In industrialized countries the share of deaths caused by occupational injuries and work-related communicable diseases is very low while non-communicable diseases are the overwhelming causes in those countries. Economic costs of work-related injury and illness vary between 1.8 and 6.0% of GDP in country estimates, the average being 4% according to the ILO. Singapore's economic costs were estimated to be equivalent to 3.2% of GDP based on a preliminary study. If economic losses would take into account involuntary early retirement then costs may be considerably higher, for example, in Finland up to 15% of GDP, while this estimate covers various disorders where work and working conditions may be just one factor of many or where work may aggravate the disease, injury, or disorders, such as traffic injuries, mental disorders, alcoholism, and genetically induced problems. Workplace health promotion, services, and safety and health management, however, may have a major preventive impact on those as well. Leadership and management at all levels, and engagement of workers are key issues in changing the workplace culture. Vision Zero is a useful concept and philosophy in gradually eliminating any harm at work. Legal and enforcement measures that themselves support companies and organizations need to be supplemented with economic justification and convincing arguments to reduce corner-cutting in risk management, and to avoid short- and long-term disabilities, premature retirement, and corporate closures due to mismanagement and poor and unsustainable work life. We consider that a new paradigm is needed where good work is not just considered a daily activity. We need to foster stable conditions and circumstances and sustainable work life where the objective is to maintain your health and work ability beyond the legal retirement age. We need safe and healthy work, for life.     

Childbearing, Stress and Obesity Disparities in Women: A Public Health Perspective

The perinatal period, from early in the first trimester to 1 year postpartum, provides opportunities for novel public health interventions to reduce obesity disparities. We present a unifying socio-biological framework to suggest opportunities for multidisciplinary research and public health approaches to elucidate and target the mechanisms for the development of maternal obesity and related disparities. The framework illustrates the interplay of the social, cultural and physical environment; stress appraisal and response; and coping behaviors on short-term outcomes (e.g. allostatic load and gestational weight gain), the intermediate outcomes of persistent insulin resistance and post-partum weight retention, and longer term outcomes of obesity and its disease consequences. Testing the proposed relationships may provide insights into how childbearing risk factors such as gestational weight gain, postpartum weight retention and parity contribute to obesity, which are needed to inform public health policies and clinical care guidelines aimed at reducing obesity and improving the health of women.     

Employment status and use of respiratory protection among metalworkers, solderers and welders

Objectives

Reported associations of self‐employment with occupational injury and cerebrovascular disease suggest that worker safety and health precautions may vary by occupational status. The authors assessed the extent to which use of respiratory protection and ventilation equipment is associated with self‐employed versus employee status among adults in an international study.

Methods

The European Community Respiratory Health Survey II (ECRHS II) is a follow‐up study conducted in a population‐based random sample of adult ECRHS I participants. Men and women enrolled in the ECRHS II completed interviewer‐administered questionnaires to provide information about their occupational status and job history during the 9‐year ECRHS follow‐up period. Respondents in selected occupational groups completed supplemental questionnaires about their jobs and use of respiratory protection and ventilation equipment on‐the‐job. The authors assessed self‐reported use of respiratory and ventilation equipment among 72 self‐employed and 371 employed adults in metalworking, soldering and welding occupations.

Results

Local exhaust ventilation (fixed extraction: OR 0.37, 95% CI 0.17 to 0.80; mobile extraction: OR 0.23, 95% CI 0.09 to 0.60; on‐tool extraction: OR 0.39, 95% CI 0.18 to 0.88) was reported less frequently among self‐employed respondents than among employed respondents. The magnitude of the negative association between self‐employment status and any of the three types of local exhaust ventilation was not attenuated by adjustment for duration of work per day or week or asthma and/or wheezing symptoms. Respiratory protection was not associated with employment status in these data.

Conclusions

More limited use of local exhaust ventilation among self‐employed workers compared to employees suggests the need to promote occupational safety among self‐employed workers.Information about the working conditions of employees may not reflect the experiences of self‐employed individuals working in the same fields. Self‐employed people who work independently or operate their own businesses may take advantage of the increased autonomy often associated with self‐employment to organise their work schedules and practices to more closely suit their professional preferences. In many industries, self‐employed workers have the opportunity to select their own hours, work settings, clients and equipment. Workers with this degree of flexibility may develop their own occupational health and safety practices, but existing information describing the working conditions of self‐employed individuals is insufficient to indicate how practices differ from those of employees, or how these differences affect health and safety.Recent research provides evidence that health and safety precautions and job training vary between workers in self‐employed and employed work situations.¹ Results from a 2005 survey conducted in the EU indicate that self‐employed workers experienced greater autonomy and less violence, harassment and/or discrimination on the job and had fewer days of health‐related absence over the past year compared to employed respondents. In contrast, the self‐employed respondents more frequently reported that they considered their health and safety to be at risk because of work and a slightly smaller percentage reported wearing personal protective clothing or equipment at work (self‐employed 29% vs employed 35%).¹ Although the survey did not include industry‐ or job‐specific estimates or health outcomes related to the use of personal protective equipment, overall these responses reveal some of the reasons individuals may seek self‐employment situations, and raise the possibility that self‐employed work arrangements may result in important health and safety risks.Previous research has shown differences in the rates of work‐related mortality among the self‐employed and privately‐employed populations.^2,3 For example, using data reported through a medical examiner''s surveillance system, notably higher fatal occupational injury rates were observed among self‐employed workers in the agricultural sector and in retail and transportation industries.² The surveillance‐based study found lower rates among self‐employed workers in the construction industry, suggesting differences in the occupational health and safety practices of self‐employed and employed individuals.² Such variations in the rates of occupational injury may reflect differences in work‐related tasks, settings, use of protective equipment or differences in the age and/or levels of work experience between the two populations. In contrast, lower rates of cerebrovascular disease have been reported among self‐employed men than among employed men. Although the differences were not observed for overall mortality or other circulatory disorders, the investigators concluded that the effect of self‐employment status was independent of those associated with other lifestyle and medical factors and thus may be considered an additional determinant of health.⁴ Differences in mortality rates between self‐employed and employed populations led the investigators to suggest considering employment status as a proxy for differences in working practices, including the physical work environment.Despite these observed differences in occupational practices, mortality and cardiovascular morbidity, occupational health and safety practices of self‐employed workers remain largely unreported in the public health literature. For this analysis, we investigated a hypothesis for which there is little epidemiological evidence—that is, whether employment status is associated with use of respiratory protection and/or ventilation equipment. We used data from the European Community Respiratory Health Survey (ECRHS), a population‐based cohort of adult men and women, to examine self‐reported use of respiratory protection and ventilation equipment among self‐employed and employed respondents.     

上海市公众职业病防治相关知识认知情况调查及影响因素分析

[目的]就上海市公众对职业病防治工作的看法、态度及相关法律、职业病防治知识的了解情况开展问卷调查,为上海市今后的职业卫生的工作重点和宣传明确方向。[方法]在全市范围选取人流密集的公共场所,采取方便抽样方法对7876人开展问卷调查,用矿检验进行统计学分析。[结果]调查对象对《中华人民共和国职业病防治法》知晓情况较好,知晓率达95．9％。具有维权索赔意识的比例为95．7％;公众认为职业病防治工作主管部门应为政府（统领全市的领导机构）及卫生部门（具体事务主管部门）;公众对职业病防治工作的评价较高,评价差的比例仅为8．7％,在职业病防治态度上,有53．5％的调查对象不知道自己工作岗位是否有职业危害因素;在职业病防治常识上,调查对象对酸碱等伤害处理常识、喷漆作业防护、电焊作业危害等方面掌握较差,男性对上述知识的知晓程度高于女性;随着年龄的增加,知晓率也呈现上升趋势,随着文化程度增高,职业病防护知识知晓率也相应增高。[结论]在今后开展职业病防治常识的健康教育中,应充分发挥社会、用人单位和个人三方的力量,针对不同文化层次、不同岗位的人群开展相应的普及宣教,将企业职业卫生培训与职业安全培训放在同等重要的地位;同时应针对重点职业危害、重点人群和重点行业开展以专业培训为主,形式多样的科学知识普及活动,提高劳动者的职业卫生知识知晓水平。     

Occupational exposure and health problems in small-scale industry workers in Dar es Salaam, Tanzania: a situation analysis

BACKGROUND: Workers in informal small-scale industries (SSI) in developing countries involved in welding, spray painting, woodwork and metalwork are exposed to various hazards with consequent risk to health. Aim To assess occupational exposure and health problems in SSI in Dar es Salaam, Tanzania. METHODS: Focused group discussions (FGD) were conducted among SSI workers. Participants were assessed for exposure to occupational and environmental hazards, the use of protective equipment and health complaints by interview. The findings were discussed with participants and potential interventions identified. RESULTS: Three hundred and ten workers were interviewed (response rate 98%). There was a high level (>90%) of self-reported exposure to either dust, fumes, noise or sunlight in certain occupational groups. There was low reported use of personal protective equipment. There was a high level of self-reported occupational health problems, particularly amongst welders and metalworkers. Workers reported their needs as permanent workplaces, information on work related hazards, water and sanitation, and legislation for SSI. CONCLUSIONS: In SSI in Tanzania, our study suggests that workers have high levels of exposure to multiple health hazards and that use of protective equipment is poor. This group of workers warrants improved occupational health and safety provision.     

Occupational health psychology: an emerging discipline.

There is growing concern that rapidly changing patterns of work organization and employment pose risk for occupational illness and injury. In the present article, we assert that these changes create new needs and opportunities for research and practice by psychologists in the area of work organization and health. We begin with an historical overview of the contribution of psychologists to the occupational safety and health field, and to the study of work organization and health. We then describe new initiatives by the American Psychological Association and national health organizations in the United States and Europe to frame a new field of study--called "occupational health psychology"--that focuses on the topic of work organization and health. We conclude with a discussion of emerging research needs and trends within this field.     

Obesity, lutein metabolism, and age-related macular degeneration: a web of connections

Age-related macular degeneration (AMD) is a major cause of visual impairment in the United States. Currently there is no effective cure for this disease. Risk factors include decreased lutein and zeaxanthin status and obesity. Obesity is also an increasing public health concern. The alarming increase in the prevalence of obesity further exacerbates the public health concern of AMD. The mechanism by which obesity increases the risk of AMD may be related to the physiologic changes that occur with this condition. These include increased oxidative stress, changes in the lipoprotein profile, and increased inflammation. These changes would also result in an increased destruction and a decreased circulatory delivery of lutein and zeaxanthin to the macula of the eye. Therefore, the mechanism by which obesity is related to AMD risk may be through indirect effects on changes in lutein and zeaxanthin status and metabolism.     

新型冠状病毒肺炎隔离病区医务人员职业风险与防控对策

 新型冠状病毒肺炎疫情对全球卫生安全造成强烈的冲击。隔离病区医护人员作为新型冠状病毒肺炎患者的直接接触者,职业损伤的危险因素包括生物、物理、化学和心理因素。如何做好隔离病区医务人员职业安全防护,使之有信心、有能力为患者实施及时有效的救治,成为医疗队亟待解决的问题。根据武汉疫区工作经验,本文对隔离病区医务人员职业损伤相关危险因素进行深入分析,建立了降阶梯式职业安全防护培训模式,设立个人防护用品指导岗位,制定职业暴露及躯体不适时的应急预案,旨在保障新冠肺炎隔离病区医护人员的职业安全,消除恐惧,增强工作信心。     

Labour standards, safety and health, and risk assessment in the fishing sector

The International Labour Organization (ILO) has, since its founding, worked towards the improvement of the working conditions of all people through various means of action, including the adoption of international labour standards. This paper will briefly discuss ILO's standards concerning occupational safety and health, its specific standards concerning work on board fishing vessels, and its work to develop a new Convention and Recommendation on Work in the Fishing Sector. It will then cover the background and debate concerning the provisions in these proposed instruments that relate to improving occupational safety and health, with a special emphasis on proposed requirements and guidance concerning "risk assessment". Examples will be provided of how "risk assessment" has been used in ILO instruments, in regional (European Union) legislation concerning the fishing sector and in national laws, regulations and practice in this sector. The objective of the paper is to stimulate debate on how "risk assessment" of safety and health matters on fishing vessels could be promoted worldwide, taking into account differing levels of development and the considerable diversity of fishing operations.     

钙与肥胖关联的证据及其机制研究进展

肥胖是心血管疾病、2型糖尿病、肿瘤等慢性病的主要风险因素。近年来人群肥胖率持续上升,已成为严重的公共卫生问题。流行病学研究提示钙摄入可能与肥胖相关。本文将对钙摄入与肥胖关联的研究证据及相关机制进行综述。     

Health protection and promotion at work

Official United Kingdom figures record annually 1400 deaths and 145,000 sufferers from chronic effects of occupational injury and disease. Evidence indicates that occupational disease directly due to work is underestimated. With more understanding of the multiple causes of disease, the concept of work related disorders has broadened to include four categories: work as a direct cause, a contributory cause, or an aggravating factor, and work offering easy access to potential dangers (alcohol). As an example, work factors that increase the risk of coronary heart disease are discussed. Evidence for work stress as a causal factor and the role of leadership are considered. Prevention depends on identifying risks, preferably before anyone is exposed, but more commonly through recognition of adverse effects on workers. The need for occupational health services to have health promotion programmes that include screening for disease and its precursors, counselling and education, is considered. The positive effects of work itself as a protector and promoter of health are discussed. Responsibility for improving health has to be shared by government, management, trade unions, health professionals, and the individual worker.     

Regulatory standard 32 and its implications for nursing workers

Workers in health care institutions often face inappropriate work situations without considering them as dangerous, however, even if scientific evidence demonstrates the presence of various occupational risk agents in work environments. This text aimed to present Regulatory Standard (RS) 32, about Safety and Health at Work in Health Care Institutions. This RS is important in the Brazilian scenario, due to the absence of federal legislation about work safety and health issues in the health sector and due to the fact that existing regulations are dispersed and joined with other RS and resolutions, which were not developed specifically for this purpose. It is concluded that the implantation of this RS may result in beneficial changes, since protection procedures and measures will have to be taken, promoting safety at work and occupational accident prevention among health workers.