A few of the recent pieces I’ve liked:
Chris Young at the Center for Public Integrity: Critic of artificial sweeteners pilloried by industry-backed scientists
Dena E. Rifkin in Health Affairs: A Fighting Chance: How Acute Care Training Is Failing Patients With Chronic Disease
A-P Hurd at CityLab: How Outdated Parking Laws Price Families Out of the City
Charles Orenstein at ProPublica: Suspicious Prescriptions for HIV Drugs Abound in Medicare
Today, the Centers for Disease Control and Prevention released new data on heat deaths among U.S. workers, underscoring the often-tragic consequences that result when employers fail to take relatively simple and low-cost preventive actions.
Published in today’s issue of CDC’s Morbidity and Mortality Weekly Report (MMWR), researchers reviewed two years worth of OSHA enforcement cases that were investigated under its general charge to uphold safe and healthy workplaces. (OSHA investigates workplace heat illness and death via the “general duty clause” of the Occupational Safety and Health Act of 1970, as the agency has yet to issue a specific heat standard.) During 2012–2013, the study found 20 cases of heat illness or death among 18 private employers and two federal agencies. In 13 of those cases, heat exposure caused a worker’s death. In the remaining seven OSHA cases, two or more workers experienced heat illness symptoms. Workers at particular risk of overheating, which can also damage a person’s brain and other vital organs, are those who work outdoors in industries such as agriculture, construction, landscaping and transportation.
In the MMWR study, most of the people worked outdoors, though seven of the cases happened indoors in work settings with a powerful heat source, such as laundry equipment or combustion engines. All of the affected workers performed heavy or moderate work. Nine of the documented deaths happened in the first three days of being on the job and four deaths occurred on the worker’s very first day. Those findings, in particular, underscore the importance of instituting workplace procedures that let workers slowly acclimate to heat. Unfortunately, the OSHA data shows that heat illness prevention programs were either incomplete or entirely absent from the workplaces in question. In addition, OSHA inspectors found no workplace provision for the acclimatization of new workers. (According to the study: “Acclimatization is the result of beneficial physiologic adaptations (e.g., increased sweating efficiency and stabilization of circulation) that occur after gradually increased exposure to heat or a hot environment.”)
Researchers also found that 13 of the employers did not have a routine way of identifying heat risk, seven employers failed to provide enough water and 13 failed to provide enough shaded rest areas. Only one of the employers implemented work-rest cycles. All of the OSHA-documented cases of heat illness and death happened on days with a heat index between 84 degrees and up to nearly 106 degrees. Overall, failure to give workers time to acclimate was “most clearly” associated with heat death. Study authors Sheila Arbury, Brenda Jacklitsch, Opeyemi Farquah, Michael Hodgson, Glenn Lamson, Heather Martin and Audrey Profitt write:
Employers need to provide time to acclimatize for workers absent from the job for more than a few days, new employees, and those working outdoors during an extreme heat event or heat wave. Employers must ensure that all workers acclimatize to hot environments by gradually increasing duration of work in the hot environment. In addition, health care providers should be aware of the loss of acclimatization in their patients who have been out of work for a week or more and counsel them that they will need time to regain acclimatization once they return to their job.
Every year, millions of people are exposed to the serious risks of extreme heat, however outdoor workers make up the largest percentage of people who suffer from heat-related illness. The MMWR study noted that in Maricopa County, Arizona, between 2002 and 2009, construction and agricultural workers accounted for 35 percent of all heat deaths among men. And in North Carolina between 2008 and 2010, heat illness was the number-one reason workers landed in the emergency room.
For more on preventing heat illness among workers, download this infosheet from CDC and the National Institute of Occupational Safety and Health, or visit OSHA’s Heat Illness Prevention Campaign. Read the full MMWR study here.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
Not an “accident”: Stanley Thomas Wright, 47, suffers work-related asphyxiation at railyard in North Las Vegas
Stanley Thomas Wright, 47, was asphyxiated on Saturday, July 2, while working inside a tank car at a railyard in North Las Vegas. The Las Vegas Review-Journal reports
- the local fire department was called to the scene at about 1:00 am
- Wright’s co-workers said he lost consciousness while inside the railcar tanker
- the railcar contained ethanol vapors and Wright was overcome by the gas
- it took fire and rescue crews until mid-day Saturday to make the scene safe
This incident brings to mind Ingrid Lobet’s reporting from May in the Houston Chronicle: “Largely invisible tank cleaning industry awash in risk.” She found 373 locations nationwide where industrial cleaning of railcar and barge tanks is conducted, but suspected there were many more. An interactive map accompanying her story did not identify any located in Nevada.
News stories to-date do not identify the victim’s employer. Nevada OSHA is conducting a post-fatality inspection of the North Las Vegas worksite where Stanley Thomas Wright lost his life. If the agency’s inspectors identify violations of health or safety regulations, the company will be cited.
Each year, dozens of workers in Nevada are fatally injured on-the-job. The Bureau of Labor Statistics reports 42 work-related fatal injuries in Nevada during 2012 (most recent available data.) Nationwide, at least 4,628 workers suffer fatal traumatic injuries in 2012.
The AFL-CIO’s annual Death on the Job report notes:
- The Nevada Department of Business and Industry’s Division of Industrial Relations has 44 workplace safety inspectors in the State. Nevada has more than 58,000 workplaces.
- The average penalty in Nevada for a serious violation of a workplace safety standard is $2,133.
Nevada OSHA has until February 2015 to issue any citations and penalties related to the incident that stole Stanley Thomas Wright’s life. It’s likely they’ll determine that fundamental safety precautions for entering a confined space were not followed, and that Stanley Thomas Wright’s death was preventable. It was no “accident.”
Next time you pass a tree, you might want to give it a second thought. Maybe even a hug. One day, that tree might just help save your life.
Let me explain. In a new study published in the Environmental Pollution journal, researchers found that the positive impact that trees have on air quality translates to the prevention of more than 850 deaths each year as well as 670,000 incidences of acute respiratory symptoms. In 2010 alone, the study found that trees and forests in the contiguous United States removed 17.4 million metric tons of air pollution, which had an effect on human health valued at $6.8 billion. The results are even more impressive when considering that trees’ pollution removal only resulted in an average air quality improvement of less than 1 percent. Every year in the U.S., poor air quality is responsible for about 50,000 premature deaths and $150 billion in health care costs.
Fortunately, trees can help — they intercept particulate matter and absorb gaseous pollutants, effectively removing pollution from the air we breathe. Researchers calculated the health-saving effects through analyzing four county-level characteristics: daily tree cover and leaf area index; the hourly flux of pollutants to and from leaves; the impact of hourly pollution removal on pollutant concentration; and the health effects and financial impact of changing levels of nitrogen dioxide, ozone, particulate matter less than 2.5 microns (also known as PM2.5) and sulfur dioxide. They finally concluded that more tree cover means greater air pollution removal, and more removal coupled with a more densely populated area results in greater value to human health.
Study co-author David Nowak, a project leader with the U.S. Forest Service, told me that while previous studies have examined the local impact that trees have on air quality, this is the first to take that question to a national scale. Nowak said that while he expected some effect on human health based on previous studies, he was surprised by the impact that trees had on human mortality.
“To be honest, I really didn’t know to expect,” he said.
In addition to reducing mortality and acute respiratory symptoms, the study found that trees and their pollution removal powers prevented 430,000 incidences of asthma exacerbation and 200,000 school absences. The study also found that tree-related air pollution removal was substantially greater in rural areas (that’s where most of the forests are), but the monetary value of pollution removal was greater in urban areas (that’s where most of the people are). California, Texas and Georgia were home to the greatest pollution removal, while Florida, Pennsylvania and California reaped the greatest value from pollution removal. Nowak and co-authors Satoshi Hirabayashi, Allison Bodine and Eric Greenfield write:
As human populations are concentrated in urban areas, the health effects and values derived from pollution removal are concentrated in urban areas with 68.1 percent of the $6.8 billion value occurring with urban lands. Thus, in terms of impacts on human health, trees in urban areas are substantially more important than rural trees due to their proximity to people. The greatest monetary values are derived in areas with the greatest population density (e.g., Manhattan).
However, trees’ pollution capturing ability isn’t always a positive, Nowak tells me. If pollution is coming in from outside of a city, the more leaves the better. However, a street or highway with a thick canopy of leaves may simply trap pollutants and prevent them from dispersing — “and we don’t want to trap pollutants where we breathe,” Nowak said.
Nowak noted that trees are just one piece of the puzzle when it comes to improved air quality and he hopes the study findings can help local officials make informed decisions about managing vegetation in and around where people live. Next, Nowak is examining the link between trees and reduced emissions from power plants via variations in energy use linked to residential buildings. (In other words, how do trees and their effects on outdoor temperatures affect how we use energy?)
“I really hope that policy people will pick it up in terms of understanding that vegetation does have an impact on human health,” Nowak said of the study. “This is just one of the many services provided by trees…they provide so much from just one system and at one cost.”
To read a full copy of the tree study, click here. And to learn more about managing a community’s vegetation and calculating the value of trees, check out this free set of software tools that Nowak and colleagues developed known as i-Tree.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
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When USDA Secretary Tom Vilsack announced last week a new regulation governing the poultry slaughter inspection system, he didn’t just have food safety on his mind. Throughout his press call, Vilsack said things like “we heard concerns about line speed,” and “we listened to concerns about line speed.” Vilsack explained that they abandoned their plan to allow certain poultry processing plants to increase line speeds from 140 birds per minute (bpm) to 175 bpm. As TPH’s Kim Krisberg wrote on Friday, that’s good news for some poultry workers who are already at risk of crippling repetitive motion injuries at current line speeds.
The National Chicken Council is not pleased with USDA’s decision to forego the line speed increase in this new inspection system.
“It is extremely unfortunate and disappointing that politics have trumped sound science, 15 years of food and worker safety data and a successful pilot program with plants operating at 175 birds per minute.”
What the chicken industry’s statement doesn’t say is what they think about the worker safety measures that made their way into the USDA rule.
First, there’ll be a new required poster. The estimated 200 poultry processors who adopt the new poultry inspection system (NPIS) will be required to display a new OSHA poster with information on symptoms of occupational injuries and illnesses, and statements about a worker’s rights to report these health conditions to their employer without fear of retaliation.
Second, there’ll be an “attestation” by employers. Poultry processors operating under the NPIS will be required to “attest” annually to USDA that they have a program to “monitor and document any work-related conditions” of their employees. The attestations will be provided annually to OSHA. The program that they’ll be attesting to have in place must include:
- Policies to encourage early reporting of symptoms of work-related injuries and illnesses;
- Assurance that the establishment has no policies or programs intended to discourage the reporting of injuries and illnesses;
- A notification to employees of the nature and early symptoms of occupational illnesses and injuries, in a manner and language that workers can understand, including the above-mentioned poster; and
- Routine monitoring of injury and illness logs, nurse and medical office logs, workers’ compensation data, and any other injury and illness information available.
What poultry workers want to know is how and by whom will these new requirements be enforced. Can OSHA enforce a USDA regulation? Will OSHA be able to throw the book at a firm that falsifies its attestation?
Third, there’s also a provision in the USDA regulation which reiterates that establishments are required to comply with all applicable laws, including OSHA’s general duty clause. Will this provision in a USDA regulation give OSHA some new legal leverage to protect poultry workers from on-the-job hazards?
Fourth, USDA says that OSHA recommends that poultry processors implement an injury and illness prevention program with the following components: management leadership, worker participation, hazard identification and assessment, hazard prevention and control, education and training, and program evaluation and improvement. USDA adds:
[It] “expects that a prudent establishment would have such a program in place.”
What poultry workers want to know is in what way does the OSHA recommendation, or USDA’s reference to “prudent establishments,” compel their employers to adopt such a program?
Fifth, the preamble also says that USDA will improve training for its inspectors so they are better able to recognize serious workplace hazards. USDA inspectors will be encouraged to make referrals to OSHA using the safety agency’s 1-800 number.
What poultry workers what to know is how this training and referral system is different than what is outlined in a memorandum of understanding between OSHA and USDA’s Food Safety Inspection Service (FSIS), which dates back to 1994. One of its key objectives was to:
“institute new procedures for meat and poultry inspection personnel to refer to OSHA serious workplace hazards affecting plant employees.”
Finally, USDA’s preamble says:
“OSHA will be paying close attention to poultry slaughter establishments.”
I’m sure it took some effort by the Labor Department to convince USDA to insert this worker safety language into its new poultry inspection regulation. The Labor Department officials who made it happen must intend for the measures to be more than just words in a Federal Register notice. Poultry workers hope so, too.
Ebola virus disease (EVD), formerly known as Ebola hemorrhagic fever, has been reported in humans since 1976, but the current epidemic of the disease – affecting Guinea, Liberia, and Sierra Leone – is unprecedented. There is no vaccine or cure for Ebola, and in past outbreaks up to 90% of people confirmed to have the disease died (the case-fatality rate is closer to 60% this time). A WHO fact sheet gives a grim list of the symptoms:
EVD is a severe acute viral illness often characterized by the sudden onset of fever, intense weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding.
In this epidemic, 1,323 confirmed and suspected cases have been reported, and 729 of those individuals have died – numbers far higher than in previous outbreaks. Last month Laurie Garrett, author of The Coming Plague and Council on Foreign Relations senior fellow, explained on PBS NewsHour why this epidemic is so worrisome:
This is the first time we have ever seen an urban as well as rural Ebola outbreak. It is the first time we have seen Ebola in the capital cities. It is the first time we have seen Ebola crossing borders, now in three countries. And it is the first time we are having an Ebola experience in an area rife with the tensions and the hostilities born out of two really brutal civil wars in Sierra Leone and in Liberia, with spillover into neighboring Guinea.
So these are three small, deeply impoverished West African countries where, in the best of times, they are hard-pressed to meet the public health needs of their people and now to have what is officially designated an out-of-control epidemic on their hands.
This is a horrific disease, but it is not transmitted as easily as some other viruses. Stephan Monroe, deputy director of CDC’s National Center for Emerging Zoonotic and Infectious Diseases, explained on a July 28th CDC telebriefing, “transmission is through direct contact of bodily fluids of an infected person or exposure objects like needles that have been contaminated with infected secretions. Individuals who are not symptomatic are not contagious.” So, as long as healthcare facilities isolate any potential cases who are showing symptoms and practice correct infection control procedures, they can control the disease’s spread.
The challenge in the affected West African countries is that patients may not all arrive at healthcare facilities, and many of the healthcare facilities where patients do show up lack the resources, such as isolation rooms and protective gear, to respond appropriately. With the affected areas not having seen Ebola outbreaks before, they are less prepared to deal with them than previously affected countries are. As a result, many of the dead — 60, according to Vox’s Julia Belluz — are healthcare workers.
Last week, World Health Organization Director-General Dr. Margaret Chan announced the launch of a $100 million response plan to bring the outbreak under control. On a July 31st CDC telebriefing, CDC Director Dr. Tom Frieden announced, “Over the next 30 days we’ll be deploying another 50 Epidemic Intelligence Service officers, other epidemiologists, and health communications experts to the affected area.” (As of July 28th, 12 CDC staff members were there already.) Frieden summarized the task that awaits those responding to the epidemic:
In past outbreaks, we have been able to stop every outbreak. But it takes meticulous work. It’s like fighting a forest fire. If you leave behind even one burning ember, one case undetected, it could reignite the epidemic. Difficult as it is, it can be done. I’m confident that as we make progress over the coming weeks and months, we will not only begin to tamp down these outbreaks, but leave behind stronger systems that will be able to find, stop before they spread and prevent more effectively Ebola and other health threats.
… We are not going to treat or vaccinate our way out of these outbreaks. We are going to use the traditional means that work of case identification, isolation, contact tracing, health communication, good meticulous management. That’s what has stopped every Ebola outbreak that’s ever happened before. That’s what will stop this Ebola outbreak.
… This is a marathon, not a sprint. This is going to take at least three to six months, even if everything goes well. We have challenges with security and health care systems that make it not the best of conditions.
Frieden stressed that “Ebola poses very little risk to the general US population.” CDC has issued a Level 3 travel warning, urging people to cancel non-essential travel to Guinea, Liberia, and Sierra Leone. The agency has also issued a Health Alert Notice to US healthcare workers emphasizing steps to identify potential cases and prevent the spread of infections from any patients with Ebola who arrive in the US. The focus now, however, is on halting Ebola transmission in West Africa and preventing an already awful epidemic from becoming even more widespread.