They take care of our most precious resource and yet most of them have to rely on public assistance just to make ends meet.
Katie Johnston at the Boston Globe wrote about a new report from the Center for the Study of Child Care Employment at the University of California, which “found that difficulties child-care workers face in making ends meet create high levels of stress that can affect their performance. Recent research has found that adverse interactions with caregivers early on can alter a child’s genetic chemistry, impairing memory, the immune system and mental health.” On average, child care workers make just $10.33 an hour, which is an increase of less than 15 cents over the national average in 1997. The highest child care wage was in Massachusetts, where workers averaged $12.47 an hour. Johnston writes:
Kitt Cox, who has a bachelor’s degree, spent most of his professional life working in child care but had to hold second or third jobs in restaurants and warehouses to supplement his income at private day-care centers and preschools on the North Shore.
“We jokingly say, on tough days, we should be saying, ‘Do you want fries with that?’ ” said Cox, 59, of Gloucester. And yet, “Kids are so much more important than burgers.”
Child-care providers are expected to plan science, literacy, and math-related activities that have been shown to aid development, said Valora Washington, president of the CAYL Institute in Jamaica Plain, a professional development group for early-childhood educators.
“Our expectations are accelerating much faster than the compensation and the recognition of those accelerated expectations,” Washington said.
Johnston reports that in a survey of 600 child care workers who earn less than $12.50 an hour, more than half were worried about being able to adequately feed their families. And nearly half of child care worker families rely on public assistance. To read the full story, visit The Boston Globe.
In other news:
ABC News: A year since Johns Hopkins Hospital promised to investigate the misdiagnoses of black lung among coal mine workers, the internal review remains unfinished, writes reporter Matthew Mosk. The article notes that Johns Hopkins doctor Paul Wheeler “never concluded, even once, that a miner had severe black lung.” One of those miners misdiagnosed by Wheeler was Steve Day, who recently passed and whose autopsy showed he had an advanced case of black lung disease. Mosk writes: “The hospital declined to make anyone involved in the internal review available for an interview, and declined to say whether qualified academics were conducting the independent look back.”
Associated Press: Reporter Kristin Bender writes that upwards of 18,000 California nurses went on strike this month to protest a decline in patient care standards within Kaiser Permanente facilities as well as inadequate health and safety standards related to the care of Ebola patients. As of earlier this month, the nurses were in the middle of contract negotiations. About the strike, a union rep said: “This isn’t about money. This is about something far deeper.”
The Nation: Reporter Michelle Chen chronicles working conditions at Whole Foods, writing that workers “are taking their grievances to the regional corporate office in Emeryville, California. Their demand is simple: ‘a $5 an hour wage increase for all employees, and no retaliation for organizing their union.’” Unfortunately, it might be a tough road for Whole Foods workers, as CEO John Mackey once compared unions to herpes. Chen writes that among their grievances, Whole Foods workers often have to deal with inconsistent scheduling practices that leave them with barely any notice to make necessary accommodations, such as arranging child care.
The Hill: Reporter Tim Devaney writes that the Occupational Health and Safety Administration is calling on the nation’s retailers to prepare to protect workers from being trampled during Black Friday, one of the busiest shopping days of the year. The article quotes David Michaels, the U.S. assistant secretary of labor, as saying: “During the hectic shopping season, retail workers should not be put at risk of injury or death. OSHA urges retailers to take the time to adopt a (crowd) management plan and follow a few simple guidelines to prevent unnecessary harm to retail employees.”
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
On Saturday, Healthcare.gov opened for enrollment in 2015 health insurance plans, and so far it’s proceeding without the horrific technical problems that greeted would-be enrollees last year. This year, as will be the case in future years, the enrollment window is just three months long. People can renew the coverage they had last year or choose a new plan. Those with incomes of between 100% and 400% of the federal poverty level (in 2014, $11,670 – $46,680 for a one-person household, $23,850 – $95,400 for a household of four) are eligible for subsidies to help them afford premiums.
The Obama administration has set a goal of having 9.1 million people sign up for coverage through the federal or state exchanges, or marketplaces (including people who are re-enrolling). That’s about two million above the current number of enrollees. They encourage current enrollees to shop again for coverage, rather than just automatically keeping the coverage they have.
As Wonkblog’s Jason Millman explains, it can be especially important for those who receive federal subsidies for premium costs to go through the shopping exercise again, because the subsidies are designed to make specific benchmark plans (the second-cheapest “silver” level plan in a location) affordable. Someone whose plan was the benchmark silver plan last year might find that there are now several cheaper plans available – so, that person will either need to switch to the new benchmark plan or pay a greater share of the premium.
People who were eligible for health insurance last year but didn’t buy it are getting an additional financial push to purchase it this time around. In 2015, people who don’t have health insurance and aren’t exempt from the Affordable Care Act’s individual mandate will have to pay a fee, which is the higher of two amounts: 2% of yearly household income, or $325 per person ($162.50 per child under 18, with a maximum of $975 per household). Next year, those figures will increase to 2.5% of household income and $695 per person; the fees will remain at that level but be adjusted for inflation in years after 2016.
Individuals are exempt from the mandate if the lowest-priced coverage available to them would cost more than 8% of household income; if they qualify for a hardship exemption (being homeless, being evicted, experiencing domestic violence, experiencing the death of a close family member, etc.); or if they fall into various other exemption categories, such as having income below the tax-filing limit or belonging to a federally recognized tribe.
The cost of plans – and, by extension, their affordability – varies by geography and by enrollees’ age and smoking status. The Kaiser Family Foundation’s Health Insurance Marketplace Calculator will let you try out individual scenarios to see 2015 premiums and subsidy amount (select “no” to question 4 on employer-sponsored insurance to see the most info). Vox’s Sarah Kliff summarizes findings from Avalere Health on 2015 premiums across the US:
A new analysis from health research firm Avalere Health showed that, on average, premiums for bronze plans (the skimpiest products) will go up by 4 percent next year. Silver plans (which offer middle-of-the-road coverage) will have a 3 percent premium increase.
But those averages mask huge variation. Average silver premiums are falling by 18 percent in New Hampshire — but increasing 28 percent in Alaska. There are two states where average premiums are going up by more than 10 percent (Alaska and Florida) and two where they’re dropping by double digits (Mississippi and New Hampshire).
And even these state figures likely mask a lot of local variation, with premium changes likely varying from city to city.
In terms of how much Obamacare actually costs, that depends on where you live and how old you are. But as a benchmark, Avalere did calculate the average silver plan premiums for a 40-year-old man. In the states that use Healthcare.gov, they range from a high of $683 in Alaska to a low of $280 in Kansas.
Premiums are only part of the cost equation, though. Lower-cost plans come with higher cost-sharing. Someone who struggles to afford the premiums on a bronze or silver plan and develops a serious illness will likely find it even more difficult to cover the co-payments and co-insurance that accompany multiple doctor visits and expensive procedures.
Those who are worst off, though, are households with income below the federal poverty level in states that have not accepted the ACA’s Medicaid expansion. The ACA as written required all states to expand Medicaid to those with incomes of up to 133% of the FPL; because that provision covered the lowest-income families, the law made subsidies for exchange-purchased insurance available only to those with incomes at or above the FPL. The Supreme Court’s decision on the ACA made the Medicaid expansion optional. Currently, 27 states and the District of Columbia are implementing Medicaid expansions, with the federal government picking up 100% of the costs through 2016 and no less than 90% of costs for this population in all future years. In the remaining 23 states, a Kaiser Family Foundation finds that nearly four million uninsured adults are in this “coverage gap,” unable to get either Medicaid coverage or subsidies to purchase a marketplace plan.
Study examines effects of San Francisco paid sick leave policy, finds low-wage workers especially benefited
As paid sick leave policies gain momentum across the country, a new study finds that such policies do indeed improve worker morale and have little overall effect on employer profitability.
Published in the December issue of the American Journal of Public Health, the study examined the effects of a 2007 paid sick leave policy in San Francisco, which became the first U.S. jurisdiction to enact a paid sick leave ordinance. (A number of states and cities have followed San Francisco’s lead — most recently Massachusetts, which passed a statewide earned paid sick leave policy by ballot measure earlier this month.) The San Francisco Paid Sick Leave Ordinance requires employers to provide paid sick leave to all workers, including part-time and temporary employees, with the leave accruing at one hour for every 30 hours worked after the first 90 days of employment. To conduct the study, researchers analyzed the 2009 Bay Area Employer Health Benefits Survey, which included interviews with hundreds of for-profit firms with more than 20 employees.
The study found that with passage of the paid sick leave ordinance, the proportion of businesses with a sick leave policy increased from 73 percent to 91 percent, with much of the gain among firms with fewer than 100 workers. By 2009, 99 percent of workplaces with more than 20 employees in San Francisco offered paid sick leave. In addition, businesses within San Francisco made the benefit available to a larger portion of employees than firms outside the city, with 76 percent of small firm employees, 91 percent of medium firm employees and 86 percent of large firm employees eligible for paid sick leave. Study authors Carrie Colla, William Dow, Arindrajit Dube and Vicky Lovell write:
The movement to ensure minimal access to paid sick leave has been likened to the campaign to enact the minimum wage: an effort to establish a floor below which no employer or worker may fall. When paid sick leave policies are targeted at vulnerable workers, such as mothers earning low wages and workers who have a lot of face-to-face contact with the public, such as restaurant employees, these campaigns present a compelling image. Congressional proposals to create emergency paid sick leave policies to reduce the spread of the H1N1 virus in fall 2009 cited the potential importance of paid sick leave in protecting public health, and public opinion polling shows very high levels of support for paid sick leave policies.
In San Francisco, low-wage workers, in particular, benefited from the paid sick leave ordinance, especially those working in the food service and accommodation sectors, the study found. Businesses in those sectors were significantly more likely to have introduced a new paid sick leave policy in response to the ordinance when compared to other sectors — for example, 35 percent of restaurants surveyed added a new sick leave policy versus 16 percent of businesses in other sectors. Still, researchers found that although businesses that employed high numbers of part-time workers, new workers and Hispanic workers were more likely to enact a new policy in response to the city ordinance, they were also less likely to offer sick leave both pre- and post-ordinance. Another interesting finding: By 2009, nonunionized firms were more likely to offer sick leave than those with unionized workforces.
Positive changes in employee morale are often touted as a benefit of paid sick leave, and the study findings underscored such messaging. Researchers found that firms that implemented a new sick leave policy were more likely to report a boost in employee morale. In addition, firms that enacted major changes in response to the ordinance also reported a decrease in presenteeism (coming to work while sick). However, firms that enacted a new sick leave policy were also more likely than firms that didn’t change their leave policy to report reductions in other employee benefits, such as less vacation time, pay raises or bonuses. Also, firms that instituted a brand new policy in response to the ordinance were more likely to report negative impacts on profitability, though the researchers noted that the “majority of firms did not report lower profits because of the mandate.” Overall, nearly 72 percent of all firms surveyed supported the paid sick leave policy.
In their conclusion, the study authors called for additional research on paid sick leave, such as its effects on employer costs, employee retention and health care spending, noting that sick leave policies could be key contributors in reducing the spread of disease.
“There are health benefits to be gained by the adoption of a paid sick leave policy: reducing spread of influenza and infectious diseases in the workplace and childcare facilities and allowing workers to visit physicians, which may reduce unnecessary hospitalization and subsequent sickness absence,” the researchers wrote.
To request a full copy of the study, visit the American Journal of Public Health.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
US attorney Booth Goodwin II and assistant attorney Steven Ruby announced yesterday a four-count indictment against former Massey Energy CEO Don Blankenship. Their four year investigation came following the April 2010 disaster at the Upper Big Branch (UBB) coal mine which killed 29 workers. The miners died in a massive coal dust explosion which could have been averted by following fundamental safety precautions.
Page 1 of the indictment sums up why Blankeship habitually broke mine safety regulations:
“in order to produce more coal, avoid the cost of following safety laws, and make more money.”
The Charleston Gazette’s Kate White interviewed some of the miners’ families. The sister of Edward Dean Jones, 50, told her:
“I had given up on it. To see him indicted means the system is working.”
The son of Rex Mullins, 50, said:
“All I can say is, I’m elated.”
The daughter of Michael Elswick, 56, said:
“It’s the best news I’ve had in four years. I thought he was going to walk away with blood on his hands.”
The father of Gary Wayne Quarles, 33, told the reporter:
“Don Blankenship was ruling this state at one time, but his time is over and I’m glad of it. We got the top dog.”
The 40-page indictment is a litany of the ways that Don Blankenship micromanaged the day-to-day operations of the Upper Big Branch mine. The document explains in detail how Blankenship knew that the mine was violating hundreds of safety regulations and that he had the ability to prevent them. He sent handwritten messages to the management executive(s) [not named] telling them to ignore safety requirements. For example:
Blankenship dismissed the need for an effective ventilation system:
“…you need to run some coal. We’ll worry about ventilation and other issues at an appropriate time. Now is not the time.”
Blankenship dismissed the need to have adequate roof bolts (which prevent the mine roof from caving in):
“Run coal. Don’t bolt for the year 2525.”
Blankenship dismissed the MSHA requirement to conduct weekly examinations of all air courses. The indictment notes that when the management executive resisted
“Blankenship chastised him for ‘letting MSHA run his mine.’”
At the same time, Blankenship was telling shareholders and the public that his company did not condone violations of mine safety regulations. The grand jury concluded that Blankenship’s statements were: “materially false, fraudulent, fictitious, and misleading,” a violation of Securities and Exchange Commission laws.
University of Maryland law professor Rena Steinzor remarked yesterday about the news:
” US Attorney Booth Goodwin has set an example for every prosecutor in the country by indicting Don Blankenship, the venal, punitive, flamboyant, and reckless former CEO of Massey Energy. For years, Blankenship demanded updates on coal production every two hours and, the indictment reveals, browbeat senior managers to cut cost and violate crucial safety. …The families of the 29 men who died can take some solace that this courageous prosecution, by a prosecutor from coal country, takes the strongest possible stand to protect miners from the most reprehensible kind of greed.”
Decreased lung function, breast cancer, miscarriage, depression and neurological disease. These are just a few of the health and disease risks that salon workers disproportionately face while on the job, according to a new report on the impact of toxic chemicals within the beauty and personal care industry.
Yesterday, Women’s Voices for the Earth, a nonprofit working to eliminate toxic chemicals from workplaces, homes and communities, released “Beauty and Its Beast: Unmasking the Impact of Toxic Chemicals on Salon Workers,” which highlights decades of research on beauty care workers and proposes a number of recommendations and policy solutions for creating healthier working conditions. According to the latest data, 1.2 million people work in the beauty care industry as hairdressers, cosmetologists, nail salon workers and other types of personal care workers, with women making up the vast majority of the sector’s workforce. Despite serious health risks, typical beauty care sector jobs tend to be low-wage ones, with the average 2011 hourly wage for hairstylists, hairdressers and cosmetologists, including tips and commission, coming to just $10.91 an hour. The report also noted that U.S. nail salon workers, of which 51 percent are Vietnamese, typically earn less than $18,200 a year. Report author Alexandra Scranton writes:
Many salon workers are contractors renting booths in a salon or misclassified as contractors (when they should be classified as employees) and thus do not have many of the same benefits or rights of being an employee, such as health care, sick leave or job security. Nail salon workers are a largely immigrant population, commonly with limited English fluency skills, which makes it difficult to access safety information or navigate the regulatory environment.
The report lists more than a dozen toxic chemicals to which salon workers are regularly exposed, some of which can be avoided by using safer alternatives. For example, dibutyl phthalate, which is found in nail polish, is a reproductive toxin and can cause birth defects; toluene, which is found in nail glue and hair dye, is associated with liver damage and pregnancy loss; ammonium persulfate, which is found in hair bleach, can lead to asthma and dermatitis; and formaldehyde, which is found in nail hardener and keratin hair straighteners, is linked to cancer and dermatitis. The result of such exposures is that 60 percent of salon workers experience adverse skin conditions, such as dermatitis, on their hands, with the problems beginning as early as cosmetology school, according to the report. In addition, salon workers are at increased risk of giving birth to low birth weight newborns, experiencing miscarriages and developing several types of cancers, including breast cancer, lung cancer and multiple myeloma (a cancer that begins in the bone marrow). Salon workers are also at greater risk of dying from neurological disorders such as Alzheimer’s and motor neuron disease.
To dig deeper into the impact of such occupational health risks, let’s look at skin conditions. According to the report, a number of studies have found that workers’ skin problems began early in their careers — for example, one study of hairdressing students in Australia found that nearly 60 percent were already experiencing skin problems on their hands. Other research found that 40 percent of Swedish hairdressers and more than 70 percent of Danish hairdressing apprentices reported hand eczema beginning during vocational training. The report also cited research finding that workers said the skin conditions made their work more difficult and disrupted their emotional and social health.
On the topic of respiratory health, the report cited a study of medical centers in 15 U.S. states that found hairdressers were four times more likely to be diagnosed with idiopathic pulmonary fibrosis, a deadly chronic lung disease, and another study of nail salon workers in Boston found that breathing problems and nasal symptoms were common work-related occurrences. In the area of reproductive health, the report noted anecdotal evidence that many salon workers tend to leave their jobs while pregnant due to concerns about chemical exposures. And while the science is still emerging on the relationships between chemical exposures and adverse pregnancy and birth outcomes, some studies do show that salon workers may be at increased risk for such problems. For example, a survey of cosmetologists in North Carolina found a slightly increased risk of miscarriage among women who worked full-time during their pregnancies, the report stated.
But despite the serious risks, report author Scranton writes that state boards that regulate the beauty industry “rarely are specific enough to address toxic chemical exposures in salons” and enforcement of existing occupational safeguards is few and far between. In addition, the U.S. Food and Drug Administration, which has regulatory jurisdiction over cosmetics, does not review all products before they hit the market and federal law does not require manufacturers to prove their cosmetic product ingredients are safe before they’re sold to customers.
To address the problem, the report offers a number of recommendations and solutions. It calls on hair and nail salons to use products free of toxic chemicals when possible, urges workers to wear protective gear, and calls on employers to ensure proper ventilation and offer employee safety training. The report also calls for stronger federal authority to regulate cosmetics as well as the establishment of local safety programs, such as this San Francisco-based program that recognizes nail salons that choose safer products.
To read a full copy of the new report, visit Women’s Voices for the Earth.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
This Veterans’ Day, it will be a cold night in most parts of the country, and especially cold for the homeless. On any given night in the US, more than 578,000 children and adults are homeless, including 31 percent who were not in shelters. Homelessness among military veterans is troubling. Nationally, 11 percent of homeless adults are veterans. These figures and many others appear in the Department of Housing and Urban Development’s 2014 Annual Homeless Assessment Report to Congress (AHAR). It was released last month.
AHAR provides estimates of homeless veterans in each state, such as 108 homeless veterans in the lesser populated state of Rhode Island, to more than 12,000 in California. Compared to 11 percent nationally, South Dakota and Wyoming have the highest proportion of homeless adults who are veterans, 21 and 20 percent, respectively. The report indicates that in most states homeless veterans were typically in shelters, however, in five states, the majority of homeless veterans were living in unsheltered locations: MT (63%), CA (63%), NV (60%), HI (58%) and GA (55%). Unsheltered locations refers living on the street, in abandoned buildings, vehicles or parks.
A 2012 report by the Inspector General of the Department of Veterans Affairs provides key data about and explained key risk factors for veterans becoming homeless.
- “Veterans who experienced homelessness after military separation were younger, enlisted with lower pay grades, and more likely to be diagnosed with mental disorders and/or traumatic brain injury at the time of separation from active duty.”
- “Substance-related disorders and/or mental illness is the strongest predictor of becoming homeless after discharge from active duty.”
With respect to veterans who were involved in “Operation Enduring Freedom” (OEF) and “Operation Iraqi Freedom” (OIF):
- Forty-eight percent of newly homeless males and 67 percent of newly homeless females had been diagnosed with some mental disorder prior to discharge from active duty.
- Homeless veterans, especially women, had received disproportionally higher military sexual trauma-related treatment (before becoming homeless) than their counterparts who were not homeless.
- “Homeless veterans were more likely to receive compensation for service-connected disabilities and have higher disability ratings.”
Former VA Secretary Eric Shinseki announced in November 2009 a plan to end homelessness among veterans in 2015. At the time, the number of affected veterans totaled nearly 75,000. In fiscal year 2014 alone, the VA committed over $1 billion in programs directed at the problem.
Since 2010, the number of homeless veterans has declined by 33 percent. Progress has been made, but 33 percent isn’t 100 percent, it isn’t even half-way to the goal. If the plan really is to end homelessness among veterans in 2015, there’s a heck of a lot still to be done.
It’s been five years since the American Federation of State, County and Municipal Employees (AFSCME) petitioned OSHA for a regulation to protect workers from infectious diseases. This week, OSHA will be taking a major step toward proposing such a rule. The agency and the Small Business Administration (SBA) will be convening a meeting of 50 representatives of small organizations (i.e., small businesses, not-for-profit organizations not dominant in their field, and local governments serving less than 50,000 residents) that would likely be affected by an OSHA infectious disease regulation. Such employers would include hospitals, doctors’ offices, and long-term care facilities which provide direct patient care, as well as a few other settings with potential exposure to infectious agents, such as laboratories, medical waste and laundry facilities. AFSCME won’t be at the table—they aren’t a small entity—but they’ll be able to listen in. So will the rest of us, and that will be a first.
The convening of small business representatives is required of OSHA (and the EPA) under the Small Business Regulatory Enforcement Fairness Act (SBREFA). The 1996 law gives “small entity representatives” (SERs) a special mechanism—not given to the rest of us—-to provide face-to-face feedback on the impact of a potential regulation long before the new rule is formally proposed. OSHA’s conversation with the SERs will take place on Wednesday, Nov. 12 (1-4 pm (ET)), Thursday, Nov. 13 (9-noon (ET)), and Friday, Nov 14. (1-4 pm (ET)). Some will be there in-person, others by telephone. OSHA is giving the public an opportunity to listen in to the conversation. (1-866-395-6878, participant code: 1294950)**
In advance of the meeting, the participants received detailed information on what the agency is considering in a proposed regulation, draft regulatory language and estimates of the cost to establishments of complying with the regulation. OSHA has that information posted on its website (and it is also posted on Regulations.gov [docket # OSHA-2010-0003]). The SERs will offer their insight and opinions during both the convening and in written comments. As required by SBREFA, all of their feedback is compiled into a report and submitted to OSHA’s assistant secretary within 60 days. The agency is expected to respond to the comments, including, by making modifications to its regulatory approach and analyses.
SBA and OSHA have 50 SERs lined-up for this SBREFA process.They include: Good Shepherd Nursing Home (Wheeling, WV), Alice Peck Day Hospital (Lebanon, NH), Lexington Regional Health Center (Lexington, NE), Abiline Family Foot Center, Southridge Village Assisted Living, Pathways Hospice, Crescent Laundry (Davenport, IA) and Hillside Memorial Park and Mortuary. They will be providing feedback on OSHA’s draft proposal to have affected employers develop a “worker infection control plan” (WICP). The WICP is designed to address three pathways of exposure: (1) contact (e.g., MRSA, norovirus, vancomycin-resistent enterococcus); (2) droplet (e.g., SARS, Ebola, pneumonia); and (3) airborne (e.g., tuberculosis, varicella zoster virus.) Other provisions of the draft proposal include medical surveillance and training.
The analysis that OSHA has already conducted suggests that 94 percent of hospitals and 42 percent of physicians’ offices already have written infection control plans. OSHA estimates that 75 percent of hospitals and 54 percent of long-term care and nursing homes provide annual infection control refresher training to their employees. (I wonder if any of the SERs will admit that they don’t have written infection control procedures?)
A few things have troubled me about the SBREFA requirement. One is that the OSHA rulemaking process already has plenty of opportunity for businesses—small and large—to provide comments to the agency on a proposed regulation. It’s the same opportunity given to unions, community groups, trade associations, and anybody else who wants to provide their views, expertise or data to the agency. OSHA proposes a regulation (albeit rarely) and we all have the same time period to submit written comments and/or participate in OSHA’s public hearings. Why should a hand-picked group of small businesses be granted the special advantage of influencing what is contained in the OSHA proposal that the rest of us will be commenting on?
Another is that workers themselves have a lot to gain and lose when it comes to worker safety regulations. Nobody’s given them the special privilege of a formal mechanism to influence what OSHA proposes in a new worker safety regulation. When it comes to worker safety, why are the voices of small businesses deemed more important than the people who actually face the hazards?
Also that OSHA’s SBREFA process happened largely behind closed doors. Not too long ago, you might hear through the grapevine that OSHA convened a SBREFA panel on a long-awaited rulemaking. But the meeting was not announced publicly—not even to just let us know that it was going to happen. In more recent years, some key stakeholders may have been invited to attend as observers to the convening of SERs, but even those invitations were hush-hush.
After nearly 20 years, I’m glad to see that OSHA will be allowing the public to listen into its convening of SERs. We’ll be able to hear for ourselves their views on a possible OSHA regulation to protect workers from infectious diseases. I’ve always been skeptical that the SBREFA process provides meaningful information that can’t be obtained during the standard notice and comment rulemaking period. I’ll find out this week whether or not that’s true.
Nov 12, 2014 Update: The Center for Effective Government released today a report on the SBREFA process entitled “Gaming the Rules: How Big Business Hijacks the Small Business Review Process to Weaken Public Protections.” Their analysis includes a behind the scenes look (made possible by FOIA) of the SBREFA process for seven proposed OSHA regulations. The authors explain the influence of industry trade associations and Washington, DC-insiders in identifying the SERs.
**OSHA had a typo on its website for the conference line. It was an 888 number, not an 866 number.
San Francisco women firefighters take part in first study on firefighting exposures and breast cancer
In the span of just a couple years, five of Heather Buren’s colleagues at the San Francisco Fire Department were diagnosed with breast cancer. At first, Buren thought the diagnoses were part of the unfortunate toll that comes with age. Still, something felt amiss — “it just felt so disproportionate to me,” she said.
Around the same time, Buren helped a good friend and mentor within the department as she underwent a double mastectomy. Buren said it was at that moment that she decided to take decisive action.
“(The cancer) just brought her to her knees,” she told me. “Now she’s good and back in the field. But in that moment when I saw this happening to her, I thought, ‘What’s going on? These are the fittest, strongest, healthiest women I know. What’s happening?’”
The experience compelled Buren to reach out to the San Francisco Firefighters Cancer Prevention Foundation, which in 2012, partnered with United Fire Service Women and a number of environmental health and cancer advocates to investigate growing concerns about premenopausal breast cancer cases within the fire department. The result was the grant-funded Women Firefighter Biomonitoring Collaborative Study, the first study of its kind to measure chemical exposures, including those chemicals linked to breast cancer, among women firefighters.
“My goal is to find out what’s going on and then, hopefully, start to change our standard operating procedure,” said Buren, one of four principal investigators on the study, a study participant and a lieutenant within the San Francisco Fire Department. “I’ve been a firefighter for 18 years and there’s things we can control and there’s so much we can’t control. I can’t choose whether or not I fight a fire, but there may be ways we can better protect ourselves from potential exposures.”
The San Francisco Fire Department is particularly well suited for this type of study, as it’s home to the largest number of women firefighters — about 225 — in the nation. Currently, the collaborative is in the midst of collecting blood and urine samples as well as gathering health and behavioral information from 80 San Francisco women firefighters and 80 city office workers, who will serve as the study’s control group. Buren said the collaborative hopes to finish the collections by Christmas, after which researchers will begin analyzing the samples. Previous research from the National Institute for Occupational Safety and Health has found that overall, firefighters tend to experience higher rates of certain cancers, including a particularly high rate of mesothelioma; however, relatively few women were included in the study.
Ruthann Rudel, a principal investigator on the Women Firefighter Biomonitoring Collaborative Study and research director at the Silent Spring Institute, said researchers will be examining the biological samples for three specific classes of chemicals. The first are flame retardants, which firefighters are exposed to via firefighting equipment and in the burning of everyday household items that contain the chemicals. The second are perfluorinated chemicals, also known as PFCs, which are used to make products more resistant to stains and water and are commonly found in sofas, mattresses, carpets and in firefighting materials. The third are products of combustion and diesel exhaust. (Buren noted that a firefighter can be stationed next to a fire truck exhaust for hours at a time as she or he pumps water onto a fire.) Rudel said that there is some evidence from animal studies that all three classes of chemicals may be contributors to mammary gland tumors.
As well as testing for those three groups of chemicals, Rudel said scientists will also use an innovative chemical analysis method known as Time of Flight to compare the firefighter and control group samples in an attempt to identify additional chemical exposures. Lastly, scientists will study the biological samples for early markers of a chemical exposure effect, such as changes in hormone levels.
“This study won’t tell us if these exposures caused breast cancer, but that there’s been an exposure to potential or likely carcinogens,” Rudel told me. “The study will tell us what chemicals are differentially exposed and that can give us clues as to how to reduce those exposures. …But I also don’t think we need to wait (to take protective action). We have a list of chemicals, we know they’re being used, we know women are exposed and we know they are likely breast carcinogens.”
Rudel noted that historically, most of what we understand about known human carcinogens came from the study of worker populations — “workers have been and continue to be guinea pigs in that way. That’s not a good thing, it’s just what happens,” she told me. And in fact, the women firefighters study could help pave the way for other groups of women workers to come forward with their own occupational exposure concerns.
“What’s so unique about this study is that although (the women firefighters) have support from the firefighter union and department, it’s the firefighters themselves who are making this study possible,” Rudel said.
So, at what point should the research start to shape policy? Nancy Buermeyer, policy implications advisor to the Women Firefighter Biomonitoring Collaborative Study and a senior policy strategist at the San Francisco-based Breast Cancer Fund, said the study results could contribute to a number of advocacy efforts, such as those aimed at better protecting firefighter health as well as more long-term activities aimed at reforming federal chemical regulations. Specifically, Buermeyer noted that the federal Toxic Substances Control Act of 1976, which provides the U.S. Environmental Protection Agency with some authority to require the reporting and testing of certain chemicals, is in desperate need of reform. Though advocates such as Buermeyer face a serious uphill battle and a very rich opponent.
“The chemical industry is extremely well resourced,” she told me. “But that’s why studies like this are so important — because the only thing that combats that kind of (industry) money is public outrage. …Being able to demonstrate with solid, strong evidence the levels of carcinogens in a population like firefighters is going to have a big impact on the public. Firefighters are extremely well respected and loved by the public and they can bring awareness to this issue in general.”
Buermeyer added that considering the current dearth of research on women and occupational exposures, she hopes the firefighter study will jumpstart additional research on work-related threats to women’s health. Buren also hopes the study will spur discussions on what can be done to better protect women and all firefighters’ health — “this is the beginning of something locally that will hopefully go globally,” she said.
During my conversation with Buren, she talked at length about her love for firefighting — “it’s a wonderful job, I love it. There’s times I can’t believe how lucky I am,” she said. As a firefighter, Buren said, you don’t stop to think about your fear, you just do your job. But cancer is a different story.
“For firefighters, cancer is really hard to look at and talk about, but we can’t not talk about it,” she said. “There is a fear. I don’t want it to be me and I don’t want it to keep happening to (my co-workers). We need to face it.”
To learn more about the Women Firefighter Biomonitoring Collaborative Study, visit http://womenfirefighterstudy.com.