After having delivered prime-time telecasts from the Olympic Games since 1988, NBC’s Bob Costas had to step aside due to a pink eye infection. Wonkblog’s Sarah Kliff opined that Bob Costas did the right thing, noting, “People turning up to work sick is actually a vexing problem for employers that could, by some estimates, cost them as much as $150 billion a year.” Sick employees showing up to work can more easily spread their diseases to co-workers and customers, as well as fellow carpoolers or transit riders.
In Costsas’ case, his initial reluctance to stay home (or in his hotel room) to recover was probably based on a desire to maintain his Olympics coverage record and spare the network the difficulty of finding a replacement newscaster. For millions of US workers, though, staying home sick can mean losing pay or even being fired. The National Partnership for Women & Families has found that more than 80% of low-wage workers – including the majority of food-service workers – lack access to paid sick days. For workers who earn the least, missing work to recover from the flu or another illness can make it hard to pay the rent or buy groceries.
The US Congress has repeatedly failed to vote on the Healthy Families Act, which would require businesses with 15 or more employees to let workers earn up to seven job-protected sick days each year. The American Public Health Association has adopted a policy statement urging the US Congress to pass a law “requiring all employers to allow employees to accrue paid sick leave,” and it supports the Healthy Families Act. In the absence of federal legislation fully addressing the problem of inadequate paid leave, APHA urges state and local governments to pass paid-leave laws, if they have not already done so – and that’s exactly what’s been happening.
The state of Connecticut and the cities of San Francisco; Washington, DC; Seattle; Portland, OR; New York City; Jersey City, NJ have all passed laws requiring that workers be able to earn paid sick days, and Newark, NJ’s law awaits Mayor Luis Quintana’s signature. Several states have made progress recently on bills that would greatly increase the population of workers with access to paid sick leave:
- California: Assemblywoman Lorena Gonzalez has introduced a bill (AB 1522) that would allow workers to earn up to three paid sick days per year, at a rate of one hour of leave for each 30 hours worked.
- Illinois: The group Women Employed leads the campaign supporting the Healthy Workplace Act (HB 2871/SB 128), which would allow workers to accrue an hour of paid sick time for each 30 hours worked, up to seven paid sick days per year.
- Maryland: Senator Catherine E. Pugh and Delegate John A. Olszewski, Jr. have introduced the Earned Sick and Safe Leave Act, which would allow workers to earn one hour of sick time for each 30 hours worked, up to 56 hours (seven days) per year. Employees could also use leave to obtain medical attention, counseling, and services for domestic violence, sexual, assault, or stalking. The group Working Matters urges supporters to turn out for a Senate Finance Committee hearing on February 20.
- Massachusetts: The coalition Raise Up Massachusetts has collected enough signatures to put an earned-sick-time measure on the state’s November 2014 ballot, along with a companion measure that would raise the state minimum wage to $10.50 an hour. The ballot initiative would allow workers to earn up to 40 hours of sick time each year, although the time could be unpaid for workers at businesses with 10 or fewer employees.
- Vermont: H 208 would allow employees to earn up to seven days of leave each year, which they could use for safe time (to take necessary steps for safety as a result of sexual abuse, domestic violence, or stalking) as well as for illness or medical issues. In its current form, the bill exempts businesses with four or fewer employees; Vermont Public Radio’s Bob Kinzel suggests that when it comes to the floor for a vote, lawmakers could offer amendments increasing the size of businesses that would be exempt.
- Washington: The state’s House of Representatives has passed HB 1313, sponsored by Rep. Laurie Jinkins, which would let workers earn five to nine sick days (the amount varies by employer size, and businesses with fewer than four employees are exempt). The Seattle Weekly’s Matt Driscoll notes that the conservative-controlled state Senate is moving in the opposite direction with SB 6307, “which would prohibit local municipalities from creating minimum wages that differ from the state’s minimum wage and also from forcing private employers to offer work leave benefits beyond what the state requires.”
Whether they’ve got pink eye, the flu, or another medical condition, workers should be able to stay home to recover – or to care for a sick family member – without fearing that they’ll lose pay or be fired. We’ll be watching these states and others to see how paid-sick-days legislation fares.
The American Cancer Society (ACS) and the American Medical Association (AMA) have offered their endorsement to the Occupational Safety and Health Administration’s (OSHA) regulatory efforts to reduce workers’ exposure to respirable silica. It’s a hazard that can cause the disabling lung disease silicosis, as well as lung cancer and other disorders. The ACS’s and AMA’s official statements of support are found in the agency’s rulemaking for its proposed silica rule. The docket closed on Tuesday for this phase of the rulemaking process.
The AMA’s support comes in the form of a policy statement the group adopted late last year. They supports OSHA’s proposal to establish a:
“stricter permissible exposure limit (PEL) for respirable crystalline silica…and a stricter standard of exposure assessment and medical surveillance requirements to identify adverse health effects in exposed populations of workers.”
The ACS, and its affiliate the Cancer Action Network’s, letter of support explains:
“Although far too many lives have been lost to occupational cancer, countless others have been prevented through regulation and control of workplace carcinogens. …OSHA presents a clear and compelling well-supported rationale for the proposed standard, and we urge that it be adopted promptly.”
And they concur with OSHA when it says:
“…common sense, inexpensive and effective control measures such as keeping the material wet so that dust doesn’t become airborne, and using a vacuum to collect dust at the point where it is created can be used to achieve adequate dust control in many settings at an affordable cost. OSHA’s analysis indicates that reducing the PEL results in benefits that substantially exceed costs.”
The ACS and AMA are not the only public health organizations that support OSHA’s effort to prevent workers from developing silica-related diseases. Others groups endorsing OSHA’s effort—or calling for greater protections for silica-exposed workers—include the American Public Health Association, the American Thoracic Society, the American College of Physicians, and Council of State and Territorial Epidemiologists.
Next month, OSHA will begin a public hearing on its proposed silica rule. It is expected to last several weeks. Business groups like the Chamber of Commerce will testify that silica-related disease is a thing of the past, and that claims about silica’s carcinogenicity are erroneous. But with endorsements from these premiere public health organizations, OSHA should feel confident that it stands on solid ground.
./../annual-report-2009/EWG_AnnualReport2009.pdf – Y
./../annual-report-2009/Templates – Y
./../annual-report-2009/actionfund – Y
./../annual-report-2009/agriculture – Y
./../annual-report-2009/ar_style.css – Y
./../annual-report-2009/contact – Y
./../annual-report-2009/credits – Y
./../annual-report-2009/donors – Y
./../annual-report-2009/energy – Y
./../annual-report-2009/favicon.ico – Y
./../annual-report-2009/financial – Y
./../annual-report-2009/i.php – Y
./../annual-report-2009/i2.php – Y
./../annual-report-2009/images – Y
./../annual-report-2009/index.html – Y
./../annual-report-2009/letter – Y
./../annual-report-2009/staff – Y
./../annual-report-2009/toxics – Y
Alpine skiiers Heidi Kloser, 21, (US); Rok Perko, 28, (Slovenia); Brice Roger, 23, (France); and Maggie Voisin, 15, (US), are some of the athletes whose dreams of an Olympic medal have come to an end. All suffered serious injuries during training or qualifying runs, which will prevent them from competing for medals. Kloser, Perko, Roger, and Voisin have something else in common. Their injuries are now part of the 2014 Olympic’s official injury and illness surveillance system.
The International Olympic Committee initially established the system for the 2004 summer games in Athens. It was limited to athletes participating in team sports, and expanded to all sports for the 2008 Beijing Olympics. For the winter games, the surveillance system was first put in place during the 2010 Olympics in Vancouver. Data from those games was presented by an international team of researchers in a 2010 article published in the British Journal of Sports Medicine. It may foretell what may happen at the Olympics in Sochi.
The surveillance system relies on the head physicians for each countries’ National Olympic Committees to submit a report each day which lists any new injury and illness cases. At the Vancouver games, two medical clinics were set up outside the Olympic village and health care providers from those facilities also participated.
An injury was defined as an event in which the athlete had to suspend training or competition for a newly-acquired musculoskeletal injury or concussion, or reinjury. Among the 2,567 athletes, 11.2 percent suffered injuries reported to the surveillance system.
The sports with the highest rate of injuries were: snowboard cross, (35 per 1,000), bobsled (20 per 1,000), alpine freestyle cross (19 per 1,000) and alpine freestyle aerials (19 per 1,000). For female athletes, the sport with the highest rate of injuries was freestyle snowboard cross (73 per 1,000) and alpine freestyle aerials (26 per 1,000). Among the male athletes, the highest rate of injuries were for those participating in short-track speed skating (28 per 1,000), and bobsled (17 per 1,000).
Among all of the 287 injury cases reported, the most common involved the knee (13.7 percent) and head (10.5 percent).
Illness cases were defined as any physical complaint (other than an injury), or exacerbation of a pre-existing health condition, in which the athlete sought medical attention. There were 181 illnesses cases reported to the surveillance system, affecting 7.1 percent of the athletes. Sixty three percent involved conditions involving the respiratory system. The sports category with the highest percentage of athletes reporting illnesses was skating (i.e., hockey, short-track, figure, etc.) Of the 432 athletes participating in skating events, 11.6 percent suffered a reported illness.
Sadly, for some of us, one particular injury from the 2010 Vancouver Olympic games stands out. Nodar David Kumaritashvili, 21, was the luger from Bakuriani, Georgia whose sled crashed during a training run. He was fatally injured.
The researchers fail to mention his name, and simply describe the incident this way:
“A catastrophic injury with death as outcome occurred in luge.”
A few of the recent pieces I’ve liked:
Karen Bouffard in The Detroit News: Infant mortality rate in Detroit rivals areas of Third World (via Reporting on Health, which has links to other stories in this series)
Stephanie McCrummen in the Washington Post: Life after Jan. 1: Kentucky clinic offers early glimpse at realities of health-care law
Harold Pollack interviews Keith Humphreys at Wonkblog: 100 Americans die of drug overdoses each day. How do we stop that?
Rachel Aviv in the New Yorker: A Valuable Reputation (“After Tyrone Hayes said that a chemical was harmful, its maker pursued him”)
Richard Conniff at Yale Environment 360: Growing Insects: Farmers Can Help to Bring Back Pollinators
Dutch Dialogues II
No city in the United States faces as grave a threat from flooding, hurricanes, and rising seas as New Orleans, part of which lies below sea level. But New Orleans architect David Waggonner and his associates, learning lessons from the Dutch, have proposed a revolutionary vision for New Orleans that seeks to make an asset of the water that surrounds the city, remaking unsightly canals into an important and scenic part of the landscape and mimicking nature to store rainfall. Waggoner’s firm has been chosen to help develop a Greater New Orleans Urban Water Plan, a first step in what could be a multi-billion dollar project to redesign the ways in which the region co-exists with water. “To sustain the city in this difficult site in an era of rising seas and more extreme weather, we must convert our necessities into niceties, into desirable places that connect with people and culture,” Waggonner says.
View the Photo Gallery
Massachusetts study: High demand for publicly funded family planning services, despite near universal insurance
Higher insurance rates don’t mean people stop seeking care at publically funded health centers, found a recent study of family planning clinics in Massachusetts. The findings speak to serious concerns within public health circles that policy-makers may point to higher insurance rates as a justification to cut critical public health funding.
Published in the Jan. 24 issue of Morbidity and Mortality Weekly Report, the study examines trends among uninsured patients seeking care at Massachusetts health centers that receive Title X Family Planning Program funds. (The federal Title X program supports access to high-quality family planning and related preventive services for low-income women and men.) In Massachusetts, which passed health reform legislation in 2006 and is often cited when trying to predict future impacts of the Affordable Care Act, researchers found that higher rates of people with health insurance had little effect on patient numbers at Title X-funded clinics. The study also found that the clinics continue to serve as a critical safety net for uninsured residents.
In addition to family planning and contraceptive services, Title X-funded clinics provide breast and cervical cancer screening, pregnancy testing and counseling, education and referrals, and testing for HIV and other sexually transmitted diseases.
“As more people get insurance, some might think that there’s no longer a need for safety net programs, but we just haven’t found that to be true,” said Jill Clark, a co-author of the study and assistant director of the Family Planning Program at the Massachusetts Department of Public Health. “From the other research we’ve done, people say they feel like they receive quality care (at these clinics), that their services are kept private and their confidentiality is respected. These are organizations that people are familiar with.”
Clark and her colleagues found that between 2005 and 2012, patient volume at Title X-funded clinics remained high. In 2012, the state’s five Title X-funded health care organizations served 66,227 patients, which translates to 90 percent of their 2005 patient volume. Also from 2005–2012, the overall percentage of Massachusetts residents served by Title X-funded organizations and who did not have insurance dropped from 59 percent to 36 percent. In 2005 and among different clinic sites, the percentage of clients who did not have insurance ranged from 77 percent to 46 percent; in 2012, those without coverage ranged from 52 percent to 24 percent. All age groups experienced declines in uninsurance, with the greatest declines among teens and adults ages 20 to 29 years old.
The overall message? Despite Massachusetts’ near universal coverage rate — 97 percent of residents had insurance as of 2011 — Title X-funded clinics continue to be critical access points for both insured and uninsured residents seeking family planning care. Authors Clark, Marion Carter, Kathleen Desilets, Lorrie Gavin and Sue Moskosky write:
The results of this study indicate that in the six years following health care reform in Massachusetts, publicly funded providers continued to be used as providers of choice for many clients with health care coverage and remained as a “safety net” for uninsured persons in need of family planning services. …The continued provision of safety net family planning services is important not just for the individual clients accessing services at these organizations but for broader health equity goals as well. Adults aged 20–29 years experience the most unintended pregnancies of any age group in the United States, and these clients constitute a large proportion of clients seen by these health centers. Yet insurance coverage among these young adults lagged behind that of other age groups.
In addition to direct clinical services, Clark told me that Title X-funded clinics are also key to effective community outreach and prevention education. Because such clinics spend years cultivating relationships with the communities they serve and have reputations for providing confidential care, they’re often better equipped to reach vulnerable and at-risk populations.
“There’s always going to be people who are not comfortable going to primary care for these services,” Clark said.
William Smith, executive director of the National Coalition of STD Directors, agreed, adding that many people simply don’t want to use their primary care doctors for sensitive health problems, such as STD screening. Plus, he said, Title X providers are often sexual health specialists who can catch diseases other providers might not. For example, lots of private providers are probably familiar with common STDs such as chlamydia, but many have probably never seen a case of syphilis in their careers.
“People really do want confidential care when it comes to sexual health issues,” Smith told me. “They want competent care and publicly funded family planning clinics and STD clinics really are centers of excellence and people know it. They know they’re going to get quality care and have providers who know what they’re doing.”
Smith said Title X funding is essential to reaching at-risk populations and preventing STD infections — “this is what public health does,” he says. And while he can’t cite an exact cause-and-effect relationship, he did note that as Title X funding has declined, rates of STDs have gone up. According to the National Family Planning & Reproductive Health Association, between fiscal years 2010 and 2013, Title X family planning funds were cut by more than $39 million. As a result, Title X clients declined from 5.22 million to 4.76 million, with no indication that they found other sources of care. Ironically, the budget cut — like many public health budget cuts — won’t save money in the long run: Research shows that every $1 invested in publicly funded family planning saves $5.68 in Medicaid costs related to unplanned births.
Even if demands for clinical services do change, Clark said that public health’s role as a trusted source of information, education and support remains the same. For example, a large portion of CDC funds for breast and cervical cancer screening must go toward direct clinical services for the uninsured. But as insurance coverage rose in Massachusetts, fewer and fewer residents qualified for the screening program. However, there was still an “incredible need” for related services, Clark said, such as patient care navigation, insurance enrollment and case management. In response, public health workers applied for a waiver and were able to use the funds to support services that help women stay in care and manage their health.
As the Affordable Care Act ushers in higher insurance numbers nationwide, Clark said that the Massachusetts study offers real lessons for public health workers and policy-makers across the country.
“We really do think it’s useful for other states as they’re figuring out what health reform means to them,” she said.
To read the full Massachusetts study, click 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.
Seven workers were fatally injured in April 2010 from an explosion and fire at a Tesoro petroleum refinery in Washington State. They were: Daniel J. Aldridge, 50; Matthew C. Bowen, 31; Darrin J. Hoines, 43; Matt Gumbel, 34; Lew Charles Janz, 41; Kathryn Powell, 29; and Donna Van Dreumel, 36. You won’t find their names listed, however, in the official investigation report prepared by the US Chemical Safety Board (CSB).
Earlier this week, TPH contributor Lizzie Grossman reported on the CSB’s recent public meeting at which it released a draft of its investigation into the Tesoro disaster. She summarized the CSB’s preliminary findings, and the reaction from family members of the deceased and their co-workers on their near four-year wait to receive the CSB’s final report.
In previous posts for TPH, Lizzie followed closely the events related to the 2010 Deepwater Horizon rig explosion, and reported ultimately on the National Commission’s detailed findings. As we chatted this week about the CSB’s Tesoro report, Lizzie remarked on a difference she noticed between the two reports: the names of the victims. Where the CSB’s report excluded the names of the workers fatally injured by the event, the Deepwater Horizon report was dedicated to the eleven workers killed in the explosion. Each was listed in the front of the report.
I’m someone who thinks there are important reasons to mention, at a minimum, the victims’ names in worker-fatality investigation reports. At the most fundamental level, the reports prepared by government agencies are an historical records of the event. Years down the road, when local news stories have long disappeared from the Web, reports with the victims’ names are memorialized and not forgotten.
Some years back, I met a young woman who was doing research in the library of the Mine Safety and Health Academy (MSHA) in Beckley, WV. She came from a long history of coal miners, and sadly, the widows and orphans left behind by deadly coal-mine hazards. The young woman was spending time in the agency’s archive hoping to find the investigation report of the incident that killed her great grandfather. (I remember, in particular, that she called him her “Paw Paw.”)
The MSHA Academy’s collection includes accident investigation reports prepared by the former US Bureau of Mines (BOM), an Interior Department agency established in 1910. This young woman was searching this part of MSHA’s amazing collection of documents. The only concrete piece of information the young woman had was the year her Paw Paw was killed. She didn’t know whether the coal mine was in West Virginia or Kentucky, and she didn’t know the nature of the incident (e.g., a coal dust explosion or a roof fall.) Combing through the accident reports—and there were many of them—she eventually found the one involving her grandfather. His name was right there in the report. It describe what he and his co-workers (who were also named) had done that day, and how the incident played out. She reacted as if the report was an important family treasure.
In conversing with the staff in MSHA’s library, I learned this: Family members, like this young woman, are some of the most frequent users of MSHA’s collection of fatality reports. The MSHA library staff understand that many children are shielded from the details of their father’s death. When they become adults, some of them have a deep need to understand what happened to him. For those families, they are unable to share the story with the next generation if they don’t have those details.
(The library staff explained a couple of historical exceptions to listing the victims’ names. In some southern states, for example, it wasn’t uncommon for prison labor to be used to fill mining jobs. Prisoners who were killed on the job were not listed in the BOM’s reports. In addition, children who worked in the mines were often not listed in a company’s payroll records, and often were not even tallied in fatality counts. )
Fatality investigation reports involving mine workers prepared by the BOM, and now, the Labor Department’s MSHA, have a long history of including the victims’ names. Not so at the CSB.
The agency’s spokesperson, Hillary Cohen, gave several explanations for their policy. The reasons include: following the model of the National Transportation Safety Board; avoiding placing blame; deferring to other agencies to provide the victims’ names; protecting the victim’s privacy; and being concerned about the reaction of the victims’ families.
Others see it differently.
“The names of workers killed on-the-job is a very important part of a fatality investigation report, and photos of the victims are even better,” Peter Dooley remarked to me. Dooley was with the United Autoworkers International Union for 20 years and involved in dozens of fatality investigations. “I believe it makes the tragedy much more real and relevant to people reading the report. It has much more impact from an educational and prevention aspect.” He added: “And, written fatality reports are the best educational tools we have for workers.”
From my own experience working at MSHA, I know that safety trainers use the agency’s fatality investigation reports in their lessons. Making the fatal incident “real and relevant” as Dooley suggests is why mine safety trainers use them.
The nation’s largest organization made up of family members who’ve had a loved one die from a work-related injury or illness has an opinion, too. The group spends hundreds of hours each year trying to find the names of worker-fatality victims. They post as many names as they can find on their website. “We feel strongly that the worker deserves to be recognized as the person he or she was, and not to be just a statistic,” Deb Koehler-Fergen told me. Her son, Travis, was fatally injured in February 2007 while employed at Boyd Gaming’s Orleans Hotel and Casino. Fergen conducts these resource-intensive searches because OSHA does not release the names in a timely, transparent manner. In contrast, MSHA promptly does so as soon as the victim’s name is confirmed (e.g., here) and long before its investigation is complete.
Tammy Miser who founded United Support and Memorial for Workplace Fatalities (USMWF), added this: “An investigation report is very personal for a family who has lost someone in such a sudden and tragic way. To a grieving family it is the last thing done in their loved one’s name. It is just plain disrespectful and insensitive to not include the names.” Miser’s brother, Shawn Boone, was fatally burned in an aluminum dust explosion at a Hayes Lemmerz plant in Indiana.
I recognize that government agencies with responsibility for conducting fatality investigations have a primary objective: to identify the circumstances that led to the loss of life. In the case of the CSB, it is also to make recommendations to relevant organizations to address those circumstances and prevent them from occurring again.
I believe that including the victims’ names in the CSB’s reports is appropriate and would be meaningful. Acknowledging the victims by name is a good place to start.
Shortly before the 48th Super Bowl, Hall of Famer and former Dallas Cowboys offensive lineman Rayfield Wright acknowledged publicly for the first time that he suffers from dementia. “If something’s wrong with you, you try to hide it,” he told the New York Times’ Juliet Macur, explaining why he had concealed his problems.
Wright, who sustained more concussions than he could count during his football career, is one of more than 4,500 players who have sued the NFL for hiding what it knew about the health risks from repeated head trauma. The NFL has agreed to pay $765 million to settle the suit, but Judge Anita B. Brody is questioning whether that amount will be adequate to cover the players’ anticipated costs from dementia, Parkinson’s disease, and other neurological problems. In another Times piece, Alan Schwarz summarizes some of the research findings on elevated rates of neurological conditions among former football players and calculates that the costs could reach $1 billion or more.
With football-related medical problems in the news, it’s hardly surprising that some college football players are seeking union representation. Players at Northwestern University have filed a petition with the National Labor Relations Board to gain union recognition. In These Times’ Alex Lubben notes that the NCAA’s emphasis on college players’ “student athletes” status has kept them from receiving wages or salaries and workers’ compensation for occupational injuries and illnesses. With union representation, players could bargain with the NCAA for a better deal.
In other news:
WVNSTV (West Virginia): The collapse of two cell towers at an SBA Communications site in Harrison County, WV, killed tower workers Kyle Kirkpatrick (32) and Terry Lee Richard, Jr. (27), as well as volunteer firefighter Michael Dale Garrett (28). The Occupational Safety and Health Administration is investigating.
NPR: As industrial chemical incidents continue to kill workers and contaminate communities, the Chemical Safety Board still has a budget and staff that are tiny compared to those of other federal agencies. It doesn’t have the authority to issue citations, and its non-binding regulations often remain unimplemented.
Press & Sun-Bulletin (New York): Scientists from the National Institute for Occupational Safety and health presented new research findings about the health of former employees of the IBM plant in Endicott. They found that workers with greater exposures to the chemicals TCE and PCE had higher death rates from some cancers.
National Institute for Occupational Safety and Health: Around 30% of injuries and illnesses involving days away from work are association with repetitive motion or overexertion. Many resources exist to help employers prevent musculoskeletal disorders.
The News (Pakistan): Advocates have mounted a national campaign to get asbestos banned in Pakistan. Worldwide, 150,000 people die each year due to asbestos-related diseases, according to the World Health Organisation.