Yesterday was the end of the first open enrollment period for people buying private health insurance plans on the federal and state-run health insurance exchanges. President Obama announced today that more than seven million people enrolled in private plans, helped by a surge of signups in the few days before the deadline. Many of these enrollees (those with incomes between 100% and 400% of the federal poverty level) were able to get subsidies to decrease their premium costs.
Severe technical problems plagued Healthcare.gov — the federally run site where residents of states not creating their own exchanges could enroll — during its first few months. (People who tried to enroll through the site but encountered technical difficulties will get an extension on the enrollment deadline.) Some state-run exchanges performed better, while others have struggled. Community health centers, local agencies, nonprofits, and others have been working hard to help people through the enrollment process.
People signing up for insurance through the health insurance exchanges weren’t just getting private coverage. In the states that have accepted the Medicaid expansion, legal residents with incomes of up to 133% of the federal poverty level have also been signing up for Medicaid through the exchanges and their state agencies. Kentucky, which established its own exchange and accepted the Medicaid expansion, signed up 360,000 residents, and roughly 80% qualified for Medicaid, reports Chris Kenning in The Courier-Journal. (The Washington Post’s Stephanie McCrummen wrote a terrific article about what gaining Medicaid coverage means for residents of Breathitt County, Kentucky.)
Total enrollment numbers are an important indicator, but another key statistic is the percentage of previously uninsured people who gained coverage thanks to the ACA. In the Los Angeles Times, Noam N. Levey highlights some key figures: around one-third of those buying coverage through exchanges were previously uninsured; the majority of the 9 million people buying plans directly from insurers didn’t have insurance before doing so; and 4.5 million previously uninsured people signed up for Medicaid coverage.
We still need to wait for specific numbers, but it’s fair to say that this is an important increase in US health-insurance coverage. It would be even larger if the 24 states that have not yet accepted the Medicaid expansion would sign on to the program. We’ll still have to watch enrollment and premium prices to see whether new enrollees maintain their coverage, premiums are stable, and enrollment keeps growing — and whether the newly insured are able to see healthcare providers when they need to.
While the numbers are important, it’s also worth remembering what insurance can mean to the people who now have it: Finally being able to see a doctor about the nagging cough, knee pain, or suspicious mole. Not fearing the moment when the medical receptionist asks about insurance. Not losing sleep worrying that a single accident or cancer diagnosis could mean bankruptcy. For millions of people, the ACA means they can spend less time worrying and more time looking after their health.
In a February 11th news bulletin, the US Occupational Safety and Health Administration (OSHA) expressed concern “about the alarming increase in preventable injuries and fatalities at communication tower worksites,” and announced it was “increasing its focus on tower safety.” At that point, five weeks into 2014, cell tower work had caused four occupational fatalities for the year – the deaths of three cell tower workers and of one fire fighter. Now, just over a month later, three more cell tower workers have died on the job. On March 19th, a 21-year old from Maryland was killed while working on a tower not far from Baltimore-Washington International Airport that was being decommissioned next to a newly built tower, and on March 25th, two workers were killed while working on a 250-foot high tower near Blaine, Kansas.
In this most recent fatal incident, 25-year old Seth Garner of Saint Peters, Missouri and 38-year old Martin Powers of Saint Charles, Missouri, were in the process of removing a 256-foot tower that was no longer in service, when the tower collapsed. Pottawatomie County Sheriff Greg Riat confirmed the workers’ names and that the tower was located at a Union Pacific Railroad site. Michael Moon, Acting Area Director for OSHA’s Wichita Area Office said in an interview that the men were working for Wireless Horizon, Inc., a Missouri-based company. Moon, explained that an OSHA investigator was on site and that OSHA was in conference with Wireless Horizon, Inc. At this point, Moon said, no other companies are involved in the investigation but that could change as things progress. Wireless Horizon, Inc. has not responded to requests for information or comment on the incident.
This is not the first time Wireless Horizon has had a fatal incident at one of its work sites. In 2005, an employee was killed in a fall from a tower while working to dismantle an unused microwave tower. According to the OSHA accident investigation summary, the work crew was maneuvering what’s called a gin pole, when part of that pole began to slide down the tower face and caused one of the workers to fall 120 feet to his death. Wireless Horizon was cited for one serious violation and initially fined $1500. The final penalty paid was $750. (Low penalty amounts, even in cases when workers die, are not uncommon due to the small size of many of the companies that employ these workers.)
The company that employed the two workers killed on February 1, 2014 also had a previous fatal accident, in 2009. In that incident the company, S&S Communication Specialists, Inc. was cited for two serious violations and fined $3,000. According to the Wireless Estimator, OSHA fines for cell tower worker fatalities range from a low of $300 to a high of $125,000.
According to a report from the Wireless Estimator, which aggregates and reports news and information about the communications tower industry, the March 25, 2014 incident also involved a gin pole, a lifting device with a series of blocks, shackles, pulleys and cables that are used to raise and lower towers. Gin poles have been involved in a number of other companies’ fatal cell tower incidents as well – incidents dating back more than 15 years. Some of these fatalities have been the subject of investigations by the National Institute of Occupational Safety and Health (NIOSH) Fatality Assessment and Control Evaluation (FACE) program.
Long-standing, unresolved issues
Fatal and catastrophic falls during communication tower construction and maintenance – resulting from gin pole incidents among others – also prompted NIOSH to issue an alert in 2001. Like the 2014 OSHA notice, NIOSH’s alert cited the increasing use of wireless communication devices as responsible for increased tower construction. It also cited fall hazards as a primary danger. According to estimates of the numbers of workers employed in tower and construction maintenance at the time, NIOSH calculated that the industry’s rate of fatalities was “nearly 10 to 100 times the average rate of 5 deaths per 100,000 workers across all industries.”
NIOSH also noted the difficulty of assessing the exact number of workers employed in communications tower construction and maintenance, as these workers were categorized in a variety of occupations. At the time NIOSH noted that a review of available data identified “118 deaths associated with work on telecommunication towers from 1992 through 1998. These deaths included 93 falls, 18 telecommunication tower collapses, and 4 electrocutions. However, the number of deaths identified here should be considered a minimum because identification methods are not exact.”
In its 2001 alert, NIOSH also noted the formation in 1997 of a task force involving OSHA, NIOSH and other federal and state agencies and military departments, working with industry to address tower safety. Gin pole safety was listed as among the priorities to be addressed.
Last year, 13 workers died while engaged in cell tower work, more than the previous two years combined. According to OSHA, most of these incidents involved falls and a lack of fall protection. Many have occurred when workers wearing harnesses were not properly anchored or tied off. Others were caused by falling objects, equipment failure and structural collapse of towers. Some of the collapses occurred because workers were not properly instructed in how to maintain the structural integrity of the towers while performing the required tasks.
“OSHA is aware that there has been acceleration in communication tower work during the past year due to cellular infrastructure upgrades, and the Agency is concerned about the possibility of future incidents, especially when the hazardous work is done by employees of subcontractors. It is imperative that the cell tower industry take steps immediately to address this pressing issue: no worker should risk death for a paycheck.
OSHA has found that a high proportion of these incidents occurred because of a lack of fall protection: either employers are not providing appropriate fall protection to employees, or they are not ensuring that their employees use fall protection properly. As a result, communication tower climbers are falling to their deaths.”
In December 2013, NATE released training guidelines for working on towers with gin poles. In February 2014, NATE launched a “100% Tie-off 24/7 Awareness Campaign” with an accompanying press release noting that “many of the tower-site accidents that compromise safety involve situations where the tower technician was not properly tied-off to the structure.” (NATE was not able to comment on the latest industry fatalities by press time.)
In an address to NATE on February 25, 2014, Assistant Secretary of Labor for OSHA David Michaels said, “We at OSHA are very concerned about this sharp rise. The fatality rate in your industry is extremely high – and tower workers have a risk of fatal injury perhaps 25 to 30 times higher than the risk for the average American worker. This is clearly unacceptable.”
As I noted when writing about this issue for The Pump Handle earlier this year, in 2013 OSHA’s records indicate at least 31 accidents – including 13 fatalities – and 267 violations in its 285 recorded inspections in the communications tower industry. In less than three months of 2014, there have been 6 fatalities and 26 violations in the 51 inspections in this industry OSHA records for this year so far, with investigations in the six fatal incidents not yet concluded.
Working at heights involves hazards that require special precautions and the demand and pace for cell tower work has been increasing. But looking back at the history, the lack of fall protection and equipment failures are clearly not new issues for this industry. The question would be why, with all the attention the issue has received from OSHA and NIOSH, more isn’t being done to make sure these catastrophes don’t continue – and what it would take for things to change.
Elizabeth Grossman is the author of Chasing Molecules: Poisonous Products, Human Health, and the Promise of Green Chemistry, High Tech Trash: Digital Devices, Hidden Toxics, and Human Health, and other books. Her work has appeared in a variety of publications including Scientific American, Yale e360, Environmental Health Perspectives, Ensia, The Washington Post, Salon and The Nation.
This year’s County Health Rankings once again illustrate why geography and good health go hand-in-hand. They’re also a poignant reminder that there may be no better way to improve health for all than by focusing on the social determinants of health.
Released earlier this week, the 2014 County Health Rankings compare each state’s counties on 29 factors that impact health, from tobacco use to high school graduation rates to access to healthy food choices. In examining the differences between counties, the report found that the least healthy counties were home to twice the premature death rate, twice as many children living in poverty and twice as many teen births. The country’s healthiest counties have better access to healthy foods, parks, exercise facilities, primary care physicians and mental health providers. They’re also home to lower rates of food insecurity and higher rates of high school graduation and college attendance (see our previous coverage of the link between good health and high school graduation). The least healthy counties have higher unemployment, more childhood poverty, more violent crime, weaker social support systems and more unhealthy housing.
What’s particularly interesting about the county rankings is viewing the state maps by health outcome and risk factors. Time and time again, counties that are literally right next to each other are wildly far apart in their health outcomes. For example, take Erath County, Texas — ranked 18 of 232 in health outcomes — and Eastland County, Texas, ranked 203 out of 232. Even though they share a border, Erath residents reported an average of 3.9 physically unhealthy days in the previous month; in Eastland, it was 6.9. Surprisingly, though, Eastland County ranked higher than Erath in health factors. For example, in Eastland, 91 percent of ninth-graders graduated high school in four years; in Erath, only 59 percent did. However, in Erath the primary care provider to population ratio was 1,739 to 1; in Eastland, it was 3,727 to 1. It’s an interesting illustration of how a complexity of components comes together to produce better health for some than for others.
This year’s county health rankings, which are a joint collaboration of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, introduced six new categories as well: housing, transportation, food environment, mental health, injury-related death and exercise opportunities. For example, in housing, the report found that in the top-performing counties, less than 10 percent of households had severe housing problems, such as lead-based paint or improper insulation. Rates of intentional and unintentional injury, such as motor vehicle crashes, suicide or poisoning, are 1.7 times higher in the nation’s least healthy counties compared to the healthiest counties. Access to exercise opportunities, like a park or recreational facility, is 1.4 times higher in the healthiest counties when compared to the least healthy counties.
Some encouraging trends rose to the surface as well. Teen birth rates have decreased by nearly 25 percent since 2007, adult smoking rates have dropped, the number of adults who’ve completed some college has gone up, and violent crime is down. Unfortunately, the rankings noted that childhood poverty is up from 18 percent in 2007 to 23 percent in 2012, and sexually transmitted disease rates have risen as well.
“The County Health Rankings show us how health is influenced by our everyday surroundings — where we live, learn, work and play,” said Bridget Catlin, director of the County Health Rankings. “The County Health Rankings often provide the spark for businesses, community planners, policy-makers, public health, parents and others to work together for better health.”
To read how your county fared, visit County Health Rankings & Roadmaps.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
Our regular readers are well aware of the hazards faced by workers in the US poultry industry (as well as related industries processing other meats), and of the USDA’s misguided poultry-inspection proposal that would allow for increased line speeds in US poultry plants. Workers, public-health experts, and other advocates have been urging US agencies to address the conditions that leave meat-processing workers with appallingly high rates of musculoskeletal disorders and other health problems, and have found the response disappointing. So, three organizations — the Midwest Coalition for Human Rights, Nebraska Appleseed, and the Southern Poverty Law Center — appealed to an international body. On Tuesday, the Inter-American Commission on Human Rights (part of the Organization of American States) held a hearing on the “Human Rights Situation of Workers in the Meatpacking and Poultry Industry in the United States.”
Tom Fritzsche of the Southern Poverty Law Center opened the petitioners’ testimony, stating, “The meat and poultry processing industries violate the fundamental human rights of their workers, who come from all over the hemisphere, by systematically exploiting the lack of work speed safety regulations in the United States. The U.S. in turn negligently permits these industries to inflict disabling harm on thousands of their employees.” He described some of the crippling injuries these workers experience, as well as indignities like being denied reasonable bathroom use, which forces workers to urinate and defecate in their clothes.
Fritzsche noted that the petitioners and other human-rights groups have asked USDA to abandon its proposed poultry regulation, and that a coalition of organizations submitted a rulemaking peition asking OSHA to establish a clear, enforceable work speed standard. Fritzsche closed with recommendations, including, “The Commission should call upon the United States government to implement work speed safety standards that reduce line speeds and permit meatpacking and poultry processing workers to perform their duties in a safe environment that does not expose them to permanently disabling, life-changing injuries. It should also call upon the U.S. government to stop the USDA’s proposed rule, which will further increase already dangerous line speeds in poultry processing.”
Omaid Zabih of Nebraska Appleseed also testified about the industry-wide conditions that endanger the lives and health of poultry workers, referencing reports their organization and others have published on meat and poultry workers’ experiences (e.g., The Speed Kills You: The Voice of Nebraska’s Meatpacking Workers and Unsafe at These Speeds: Alabama’s Poultry Industry and its Disposable Workers) as well as research findings. I gave a brief statement about the decades’ worth of findings in the peer-reviewed literature and government research about health problems among workers in these industries. But the stars of the hearings were three workers and the mother of a worker killed on the job, who shared firsthand stories of the awful toll of unsafe working conditions in meat and poultry-processing plants.
“What I wanted … was to be treated like a human being”
Teresa Martinez packed 40-50 hams per minute, for eight hours a day, for more than four years at a Nebraska meatpacking plant. When she first reported shoulder pain, her employer gave her pills and ice; then, they cut her hours. “What I wanted … was to be treated like a human being and not some replaceable machine,” Martinez told the commission, but supervisors kept hounding the workers to speed up production. Eventually, the pain was so bad that she couldn’t lift her baby, or even raise her arm. After three years at the plant, she needed surgery — but it didn’t stop the pain. Two years later, she has stopped working at the plant, but intense pain still wakes her at night. “The doctors say the pain his permanent,” she told the Commission. “I have dreams and a family. The speed of the line broke my dream.”
Gwen Clements worked at a Kentucky poultry processing plant, layer-packing 47 chicken legs per minute. Performing those same motions day after day eventually left her with hand pain, which worsened despite medications, creams, and wrist splints from the company nurse. A neurologoist diagnosed early-stage carpal tunnel syndrome, but the company disputed it. The nurse told Clements’ supervisor to slow down the line speed and then gradually increase it — but the supervisor didn’t follow the nurse’s instructions. “I never once saw the supervisors slow down the line for anyone,” Clements explained, not even for new hires who are supposed to start working at slower speeds. “We are under too much pressure to meet the daily orders. The company does not follow its own policies.” After more than a year on the job, Clements was fired. “I believe I was fired for complaining to the company about my work-related health problems,” she told the Commission. “Unfortunately, my story is not unique. Many of my co-workers also suffered from the dangerously fast work speeds. And many were fired when their injuries got worse.”
Juan Martinez spent more than eight years trimming ribs in Nebraska meatpacking plants. After making the same cutting motions thousands of times every shift, his fingers locked; after lifting heavy buckets of meat and fat, he injured three discs in his back. His doctor set work restrictions, and the company laid him off soon thereafter. “When you’re injured, the company no longer wants you,” Martinez explained. “My friends who reported their own accidents have lost their jobs. Others hid their injuries because they feared being fired.” Juan has undergone two surgeries on his hands and two on his back, as well as many hours of therapy, but the pain doesn’t stop. He has lost strength in his hands and legs, as well as his ability to grip. “Imagine being disabled at the age of 41,” he told the Commission. “I’ve come to learn that when you’re injured on the job at the packing plants, it becomes nearly impossible to find a job. We need policies that keep the speed of the work safe. I don’t want more people to become disabled just because they’re trying to do their job.”
Lee Pearl Duff spoke about the death of her son Ronnie Duff, Sr., who worked at a Mississippi chicken processing plant until September 9, 2012, when he was pulled into an unguarded screw auger with no accessible emergency-shutoff equipment. “His left side was completely gone, the leg from the hip and the right side was completely crushed,” she told the Commission. “If they could have shut the machine off, I might have a son without any legs, but since they couldn’t shut it off, I don’t have a son.” An OSHA investigation found 43 health and safety violations at the plant, 37 of them serious. “He was a good man, just trying to take care of his family and build a life. He was only 39 years old, and he leaves behind three children of his own. Now his life is gone because someone didn’t consider him to be even as important as a bird.”
After sharing her son’s awful story, Lee Pearl Duff voiced a sentiment that we hear over and over again from family members speaking about their loved ones who were killed on the job:
No family should suffer the anguish that is now in my heart over the preventable loss of my son. … Since my son’s tragic death, it has been my number one goal to do everything within my power to prevent this devastating and senseless loss from happening to another family. In the moment that my son was caught up in this machine, he knew in an instant that he was going to die and he endured a torturous death. The mental picture of my son’s last moments on this earth will haunt me until I go to my own grave.
The condition in these plants for years has caused injuries to thousands of workers. So I come to you with a heavy heart asking that you consider my request along with the others that are being made on behalf of thousands of workers and have been injured in the poultry industry.
Responses from federal agencies and the Commission
After the petitioners spoke to the Commission about the human-rights abuses occurring the US meat and poultry industries, representatives from US government agencies also had a chance to testify. Andrew Levinson, Deputy Director of the Directorate of Standards and Guidance at OSHA, echoed several of the petitioners’ points about the high injury and illness rates among meat and poultry workers, and noted that several factors — repetition, force, posture, and temperature — can affect the development of musculoskeletal disorders. He explained that OSHA has limited enforcement resources and that the agency’s rulemaking process takes many years to complete. Levinson mentioned several steps OSHA is taking to address worker health and safety in these industries, including a National Emphasis Program on amputations, partnerships with the consulates of several Latin American countries whose citizens work in meat and poultry processing, and outreach to vulnerable workers (in Spanish as well as English) that stresses the confidentiality of complaints filed with OSHA.
Rachel Edelstein, Assistant Administrator of the Office of Policy and Program Development at USDA’s Food Safety and Inspection Services (FSIS), spoke about the need to modernize poultry inspections to better address the bacteria responsible for foodborne illnesses. (It’s worth noting that many food inspectors and food-safety advocates warn that the proposed system will not only be harmful to workers, but will likely fail to improve food safety.) Edelstein testified that FSIS does not have authority or expertise on worker safety, but will continue to collaborate with OSHA. This was a disappointingly vague response, but it wasn’t surprising.
Commissioners’ questions following the testimony were focused mainly on better understanding the problem, including how meat and poultry processing conditions affect immigrants and how unions are, or could be, involved. Commissioner Emilio Álvarez Icaza commented that it appears US agencies are not doing enough to address the problem. Commissioner Rose-Marie Antoine, who chaired the hearing, told the audience that the Commission will continue to monitor the situation.
It remains to be seen whether USDA will issue a final version of its “modernization” rule, which will shift food-inspection responsibility from federal inspectors to poultry companies and allow processing plants to run their lines at speeds beyond the worker-damaging pace allowed today. With their appearance before the Inter-American Commission on Human Rights, poultry workers and advocates continue to show why we need to be just as concerned about working conditions as we are about food safety.
Yep. “We’re not stupid” was just one of the many memorable moments at last week’s public hearing on OSHA’s proposed rule on respirable crystalline silica. The remark came from epidemiologist Robert Park of CDC’s National Institute for Occupational Safety and Health (NIOSH). He was compelled to respond to a comment made by Tony Cox, a consultant retained by the American Chemistry Council.
Cox, who was expounding on the OSHA’s peer-reviewed risk assessment, asserted that the agency has not demonstrated a causal link between silica and lung disease at OSHA’s proposed permissible exposure limit of 50 ug/m3. The industry consultant’s opinion is grossly out-of-step with the abundance of literature concluding otherwise. It also ignores the history of silica-related disease dating back centuries involving silica-exposed workers. That history was more than enough for NIOSH to recommend to OSHA in 1974 that it adopt the 50 ug/m3 exposure limit. Forty years later, when OSHA is proposing that exact 50 ug/m3 limit, the evidence is stronger than ever.
Many in the audience and the OSHA staff likely expected some of the witnesses to make some fringe assertions about the science, but that one about causation was laughable.
Other opponents of the rule have provided a litany of uncertainties that they insist OSHA must assess before moving forward with its rule. Just on the subject of exposure monitoring and analysis, the long list of potential biases offered by them include:
cyclone particle distribution, dust weighings, balance calibration, particle size in calibration standards, linear range of calibration standards, low limit of quantitation, calculations, errors in pump calibration, errors in cyclone calibration, cyclone leakage, filter cassette leakage, improper flow rates, cyclone particle distribution, cyclone contamination, and contamination during shipping.
The long litany of criticisms about the scientific basis for the rule have—and will continue— to be made throughout the rulemaking. These criticism will persist years down the road when the rule is challenged in court. This is just part of the typical life cycle for developing a new OSHA standard.
A bright spot for some at last week’s hearing, but a frustration for others, was the testimony of the National Industrial Sand Association (NISA). The trade association represents 31 firms that mine and process 100 percent pure silica. NISA representatives testified primary about their 30-year old Silicosis Prevention Program (SPP). They credit the SPP with preventing the disabling and deadly disease silicosis among workers of the member companies that have implemented the program. (NISA is in the midst of an epidemiological study to determine whether that claim is true. Study protocol reviewed by NIOSH. Result expected in late 2015.)
When NISA kicked off its testimony saying this:
“NISA members strongly believe that the exposure monitoring and medical surveillance that they implement …must be included in a comprehensive OSHA standard addressing crystalline silica.”
Opponents of the rule sunk into their seats, and were dreading what NISA would say next.
Mr. Andrew O’Brien of Unimin Corp—the largest producer of industrial sand in the world and a firm with 2,400 employees—asserted that the costs of conducting exposure monitoring and medical surveillance are “quite minimal.” [Cringing in the audience by opponents of the OSHA proposal.]
“Our experience shows that companies don’t need to hire outside contractors to competently conduct exposure monitoring. Company staff can be trained to do it competently.” [Groaning in the audience by the opponents.]
In NISA’s written comments to OSHA, the group estimates the cost to conduct exposure monitoring is between $106 and $127 per sample. That’s significantly more than OSHA’s projection. Moreover, for construction employers who want to avoid doing exposure monitoring at all, OSHA is offering something easy. For 11 of the dustiest tasks in construction, such as using a masonry saw or drywall sanding, if the employer uses a prescribed set of simple controls, they will be deemed to be in compliance with the rule. They would incur no cost for exposure monitoring.
The NISA endorsement of exposure monitoring and medical surveillance caused some positive head nodding in the audience from proponents of the rule. Their reaction was not surprising given what they’d heard the day before from witnesses retained by the Chamber of Commerce. But some proponents of a rule were not ready to concur with all of NISA’s pitch to OSHA. The trade association urges OSHA to maintain the current PEL of 100 ug/m3, but adopt the other provisions of its proposal. That is one of the alternatives offered by OSHA in its proposal.
This week’s line-up of witnesses includes those representing the Building and Construction Trades Department, AFL-CIO, the United Autoworkers, the National Association of Manufacturers, the American Chemistry Council (again) and the National Asphalt Pavement Association. On Thursday, a small delegation of non-union workers from Houston and New Jersey will describe their experiences working in silica dust. They will be a reality check for those who are paid to manufacture uncertainty when it comes to health protective regulations.
By Anthony Robbins, MD, MPA
I am surely not an expert on cholera. I have never seen a patient with the disease. And I have never been to Haiti. Yet I keep reading about the epidemic in Haiti. The first case reports appeared in October 2010, about 10 months after the powerful earthquake that shook Haiti. Unrepaired damage to hospitals, clinics, and roads made it difficult to bring oral rehydration to patients with cholera. The country lacked potable water and infrastructure to treat human fecal waste. By 2014, at least 700,000 Haitians had been infected and more than 8000 had died. The disease continues to spread.
Cholera had spared Haiti for a century or more, so it was not unreasonable that people asked where did the pathogen come from in 2010. But public health people might have explained that the question was a distraction. Why so? Very simply, knowing how Vibrio cholerae arrived in Haiti would not help control its spread or prevent future outbreaks.
As Declan Butler reported in Nature: “Cholera is a disease of poverty, and spreads rapidly in communities lacking clean water supplies and sanitation.” “Until clean water and sanitation are readily available in Haiti, cholera outbreaks will continue.”
Early this year I realized that this public health message was often shoved off course.
- At a board meeting of the Public Health Advocacy Institute, a lawyer working with Haitian cholera victims told us of his efforts to win compensation from the United Nations. It seems that the strain of cholera afflicting Haiti came from Asia and may have been imported by Nepalese soldiers participating in earthquake relief efforts.
- A similar focus on the source of the Vibrio cholerae received excessive attention in a draft policy statement for the American Public Health Association.
I pulled out my editor’s pen and wrote an Editorial for the Journal of Public Health Policy. Now I have been invited to opine on cholera in Haiti on Scientific American’s guest blog. In my JPHP editorial, I wrote:
The bottom line is that all low-income countries that lack potable water and sanitation are vulnerable. Haiti presented an ideal environment for cholera to spread. But it might have struck other communities in other countries. The world must invest in the infrastructure that will prevent the kind of epidemics we are witnessing in Haiti. Most of the world, middle- and high-income countries, was made safe from cholera before we could identify the pathogen or treat the disease with oral rehydration fluids.
Anthony Robbins, MD, MPA is co-Editor of the Journal of Public Health Policy. He directed the Vermont Department of Health, the Colorado Department of Health, the U.S. National Institute for Occupational Safety and Health, and the U.S. National Vaccine Program.
recently launched the “What We Know” campaign, designed to cut through the fog of misinformation about climate change and convey to the public the current state of climate science. Chairing that effort is Mario J. Molina, a chemist who won a 1995 Nobel Prize for his work on the threat to the world’s ozone layer. Yale Environment 360 asked Molina five questions about the AAAS campaign and why it might succeed where previous efforts have failed.
Thanks to a unanimous vote of California’s Occupational Safety and Health Standards Board last Thursday, workers get to hold on to a robust chemical right-to-know rule that puts their health and safety first. The vote also means that California workers will reap the benefits of more meaningful right-to-know rules than those at the federal level.
“It’s a human right to know about the hazards of the work you’re doing,” said Dorothy Wigmore, occupational health specialist at Worksafe, a state-based organization dedicated to eliminating workplace hazards. “If employers don’t know about the hazards of the chemicals in the workplace, and if workers don’t know about those hazards, how can we prevent people from getting sick and dying? For me, that’s why it’s a fundamental issue in health and safety.”
Thursday’s vote concerned California’s Hazard Communication (HazCom) rule and whether the state should have blunted its regulation in favor of coming in line with less stringent rules that the federal Occupational Safety and Health Administration adopted in 2012. California’s 1980 HazCom law predates the federal one by three years. Wigmore told me that it goes back to a group of workers who discovered that the DBCP pesticide they were making was causing their infertility.
Under right-to-know laws, manufacturers and suppliers decide if ingredients in their chemical products are hazardous and produce data sheets and labels to provide information about those effects and guidance about how to use the product. Employers must tell workers about the hazards and train them about how to use the product safely as well as how to use the data sheets and labels.
The California rule will continue to require those preparing data sheets and labels to use several ”floor lists” about toxic chemicals. It also employs a one-study threshold for disclosing health hazards, which means that just one positive study, done using “established scientific principles,” is reason enough to inform workers of a possible hazard.
The recent question before California’s Occupational Safety and Health Standards Board was this: How should California revise its chemical right-to-know rule to be at least as effective as the federal OSHA standard that adopted parts of the international agreement called the Globally Harmonized System of Classification and Labeling of Chemicals (GHS). The GHS is supposed to replace the varying systems that countries use to classify hazardous chemicals with uniform categories and criteria. Data sheets and labels should be the same around the world.
But adopting just the federal standard would leave California workers without information based on authoritative lists or the one-study rule. The GHS agreement — and federal OSHA — dropped both requirements in favor of the “weight of evidence” approach. That approach allows manufacturers to decide what studies they will accept — in other words, unethical manufacturers could cherry-pick studies that suit their interest, Wigmore said.
Not surprisingly, the chemical industry was in favor of the California board voting to go the way of federal OSHA. On the other hand, Worksafe and more than 50 other organizations representing unions, public health and environmental health groups supported Cal/OSHA’s efforts to retain important parts of the current regulation. Worksafe predicted that the change would “lead to a ‘wild west’ of (safety data sheets) that may be nicely formatted but cannot be trusted to have full and accurate information about hazards.”
“For workers, what’s at stake is do we really have the right to know about the hazards of the chemicals we use on the job,” Wigmore said. “It’s a substantial weakening of a worker’s right to know…Just adopting the 2012 federal standard would have taken us back many years, in my humble opinion.”
In a letter to the chair of the board, Wigmore noted that under GHS, the “’weight of evidence’ doesn’t always weigh the same.” The Worksafe website offers this example:
Consider the case of styrene, a chemical considered carcinogenic by the National Toxicology Program, along with a host of other hazards. The chemical’s data sheets from Chevron Phillips, an international company, differ from country to country, although they were all apparently prepared on the same day by the same department. In China, for instance, the data sheet indicates that styrene belongs to four GHS health hazard categories, while the Japanese sheet list 14, the Korean sheet has 10, and the U.S. sheet has nine health hazard categories listed.
In fact, the U.S. 2011 Chevron styrene data sheet said the chemical met the GHS criteria for carcinogenicity. That’s gone in 2014, as though the “weight of evidence” has mysteriously shrunk in the United States.
If a multinational company like Chevron “harmonizes” its labels and data sheets to what they can get away with in a particular jurisdiction, what will others do? How can the chemical industry be trusted to provide complete and accurate information about their products without being told to use authoritative lists for carcinogens and other health hazards? How can they be trusted to use exceptions properly?
The answer, of course, is that they can’t.
Fortunately, California’s board responsible for health and safety sided with workers last week. Some board members also picked up on the message from many worker and public health advocates: the changes are necessary but not sufficient, and improvements are needed.
“Worksafe has been fighting for workers’ right to know for years and we’re not going to give up,” Wigmore said. “They haven’t heard the last of us.”
Many thanks to Dorothy Wigmore for her help and contributions to this article.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.