Researchers with Michigan State University’s (MSU) Department of Occupational and Environmental Medicine have done it again. First it was work-related burns. Then it was work-related amputations. Now it is work-related skull fractures. The MSU researchers continue to poke holes in the federal government’s annual estimates of occupational injuries.
Joanna Kica, MPA and Ken Rosenman, MD used data from acute care hospitals, workers’ compensation records, death certificates and police reports to identify work-related fatal and non-fatal skull fractures occurring in Michigan in 2012. They identified a total of 316 work-related skull fractures, six of which were fatal. Facial and non-facial fractures totaled 218 and 98, respectively. The authors note their interest in this particular category of work-related injuries because skull fractures are considered to be among the most severe types of traumatic brain injuries. TBI’s can cause permanent impairment and recovery can require extensive long-term treatment. Moreover, as with most work-related injuries, illnesses and fatalities, TBI’s can be prevented.
But when reporters and policy makers talk about work-related injuries, they are likely to refer to data from the Labor Department’s Bureau of Labor Statistics (BLS), specifically its Survey of Occupational Injuries and Illnesses (SOII). Instead of the actual count from Michigan of 316 work-related skull fractures, SOII indicates there were 170 cases. That’s a difference of nearly 54 percent.
Kica and Rosenman demonstrate the value in using multiple sources to assemble data on work-related injuries. Of their 316 cases, 193 were identified by hospital/emergency department records; another 100 cases were identified by both workers’ compensation records and hospital data.
BLS’ SOII, in contrast, uses data from a survey of about 200,000 workplaces—a representative sample of all U.S. workplaces—to estimate work-related injuries and illnesses. SOII’s biggest limitation is that it depends on self-reported data from employers. Some employers might misunderstand what they are supposed to report, others may intentionally deceive the government. Either way, the SOII data should be used with caution and with caveats.
SOII is also incomplete. Some work-related injuries aren’t captured in the data because small farms, independent contractors and the self-employed are not included in the survey.
Previously, the MSU researchers published papers comparing BLS’ estimates of work-related amputations in Michigan to the number of cases ascertained using multiple data sets. They calculated that BLS missed about half of them. Similarly, they found that the BLS system also missed about 70 percent of work-related burns that occurred in the State. I’ve no reason to believe that the undercount in BLS’s data for Michigan isn’t repeated in every other State.
Much of the October 2014 issue of the American Journal of Industrial Medicine (AJIM) is devoted to exploring ways to improve BLS’s SOII. Writing in the issue, Emily Speiler, JD and Greg Wagner, MD, MPH explain why it matters:
“Underreporting obscures reality and misleads all of the key stakeholders when issues of work and health are discussed—in workplaces, employers’ organizations, trade unions, administrative agencies, research organizations, and in the courts. In essence, underreporting is a denial of the experience of workers injured or sickened by workplace exposures and conditions.”
Rosenman and colleagues are doing a service to their State—and the rest of us—by providing a reality check on the incidence of work-related injuries.
Best American Science and Nature Writing 2014, edited by Pulitzer-winning writer and professor Deborah Blum, features two pieces that remind us how public-health interventions can become less effective if we as a society don’t use them appropriately — and, based on the spelling of the authors’ last names, they’re right next to each other in the anthology. Maryn McKenna’s “Imaging the Post-Antibiotics Futre,” published in Medium, and Seth Mnookin’s “The Return of Measles” from the Boston Globe Magazine warn that diseases we thought we’d conquered could easily return and become major killers once again.
McKenna, author of SUPERBUG: The Fatal Menace of MRSA and the Superbug blog at Wired, has written extensively about the rise of antibiotic-resistant bacteria. She notes in her Medium piece that 80% of the antibiotics sold in the US are used in agriculture, and that a growing body of research links the use of antibiotics in livestock to the emergence of these resistant organisms. The 20% of US antibiotics prescribed to humans also play a role; inappropriate prescriptions (e.g., for viruses that won’t respond to antibiotics) and patients’ failure to take complete courses of the drugs also contribute to resistant bacteria’s rise. This, McKenna explains, will have severe repercussions for healthcare:
Without the protection offered by antibiotics, entire categories of medical practice would be rethought.
Many treatments require suppressing the immune system, to help destroy cancer or to keep a transplanted organ viable. That suppression makes people unusually vulnerable to infection. Antibiotics reduce the threat; without them, chemotherapy or radiation treatment would be as dangerous as the cancers they seek to cure.
… Antibiotics are administered prophylactically before operations as major as open-heart surgery and as routine as Caesarean sections and prostate biopsies. Without the drugs, the risks posed by those operations, and the likelihood that physicians would perform them, will change.
Mnookin, author of The Panic Virus: The True Story Behind the Vaccine-Autism Controversy and associate director of MIT’s Graduate Program in Science Writing, focuses in his piece on measles — which, he notes, might not sound as terrifying as AIDS or Ebola, but which frightens public-health officials because it has a transmission rate of 90%. A timeline accompanying the article notes that in 2000, “a panel of experts declared measles eliminated in this country.” Now, though, more children’s parents are citing religious or philosophical reasons for not getting their children vaccinated, and these families are often clustered in the same geographic areas. That means that a single child with measles could potentially spread the disease to several unvaccinated classmates or neighbors. Public-health officials must respond swiftly to each new measles case, identifying people who could have been exposed and checking their vaccination status.
Mnookin gives the example of a recent “all-hands-on-deck” response from the Massachusetts Department of Health when two unconnected patients presented at hospitals with active measles infections. Such responses are important, and not cheap. Mnookin writes:
As the containment efforts illustrate, the fact that there haven’t been any recent deaths in the United States doesn’t mean measles isn’t having a real impact on the economy or on public health. One of the reasons [director of Massachusetts' Division of Epidemiology and Immunization Larry] Madoff oversaw an effort in Massachusetts to contact everyone who might have been exposed was to make sure they were OK. Another was to identify anyone who wasn’t vaccinated so they could “isolate themselves and be out of work and out of school.”
The state isn’t releasing estimates for the total cost of these two infections, but a 2010 study in Pediatrics quantified the expense of containing a 2008 outbreak in San Diego in which 11 children were infected — and another 839 people were exposed. That cost the public sector $124,517, an average of more than $10,000 per infection. These are costs borne by all of us: Every tax dollar spent containing measles is a dollar not spent on other public health initiatives.
Developing a new antibiotic or vaccine can take massive investments of time and money, but once it’s done, it’s done. By contrast, assuring the ongoing appropriate use of drugs and vaccines by the entire country is a neverending task. It’s easy for lawmakers and the public to forget that public health requires ongoing investments, even if it doesn’t result in headline-grabbing achievements. As these two pieces remind us, though, failing to be vigilant on how we use our medical breakthroughs can mean they no longer protect us as well as they used to.
The experience of Pennsylvania nurse Jessica Wheeler starts off Esther Kaplan’s piece on workplace speedups in The Nation. The article begins:
Wheeler recalls one night when she had a patient who couldn’t breathe and several others under her care. “I called the supervisor to ask for anybody—a nursing assistant, anybody! And I didn’t get it, and my patient ended up coding.” Another night, Wheeler had a post-op patient who required constant attention; the patient was confused and sick, and she soon escaped her restraints and pulled out her drains, spraying fecal matter all over the wall. Early the next morning, her heartbeat became irregular just as another patient was dying. “Those nights are scary,” Wheeler says. “I think I’ve seen everybody on our floor cry.”
However, Kaplan reports that the hospital Wheeler works at wasn’t always “out of control.” In 2009, the once nonprofit hospital was bought by the nation’s largest for-profit hospital chain and since then, nurse staffing levels have dropped by more than 10 percent, which means the “nurses are not only juggling more patients, says Fran Prusinski, a critical-care nurse who’s been at the hospital for thirty years, but ‘they have to change the linens, empty the garbage and answer the phones.’”
Kaplan writes that the hospital situation is just one example of the “hidden side” of the economic recovery — that employees are being expected to work faster and faster, resulting in more injuries and heightened stress. For example, Kaplan cited a 2013 survey conducted by the United Steelworkers that found that production pressure, the increased pace of work and bigger workloads topped workplace health concerns. She writes:
In our increasingly polarized economy, it seems, squeezing workers to the breaking point is just another way to maximize gains at the top. But we’re all absorbing the cost of doing business, if not in broken backs and ribs and shattered sleep, then in unsafe food and roads and hospitals. Little in our regulatory system takes on the risks of work speedup.
To read the full article, which includes interviews with workers in the meatpacking industry and a more in-depth look at work speedups in the health care sector, visit The Nation.
In other news:
In These Times: Two groups of northern California recycling workers recently took action to improve their working conditions — one group voted to unionize and the other went on strike. Reporter David Bacon writes that one of the employers, Waste Management Inc., despite its billions in revenues, refuses to settle a new contract with the local union, resulting in a strike; at the other facility, Alameda County Industries, workers overwhelmingly voted to unionize. Bacon reports: “Sorting trash is dangerous and dirty work. In 2012, two East Bay workers were killed in recycling facilities. …And in the Bay Area, the sorting is done almost entirely by women of color, mostly immigrants from Mexico and Central America and African Americans.”
Texas Tribune: Writer Alana Rocha reports via video on the new challenges facing emergency responders in Midland, Texas, where a boom in energy production has brought a “new set of hazards to communities facing the bulk of the drilling — including an increase in traffic accidents and chemical spills. That means more work for already understaffed emergency response units across small-town Texas.” And in addition to responding to more emergencies, Rocha reports that Midland’s first responders are struggling to make ends meet, as the energy boom leads to higher and higher costs of living. The piece is part of the tribune’s “The Shale Life” project.
EHS Today: OSHA has cited Ringling Bros. and Barnum & Bailey Circus for an incident during a “hair hang act” in which eight performers fell 15 feet to the ground — all the workers, including another one on the ground, sustained injuries. Reporter Sandy Smith writes that an OSHA investigation found that the carabiner used to support the performers failed because it was improperly loaded. Smith quotes OSHA administrator David Michaels saying: “This catastrophic failure by Ringling Bros. and Barnum & Bailey Circus clearly demonstrates that the circus industry needs a systematic design approach for the structures used in performances — approaches that are developed, evaluated and inspected by professional engineers.” OSHA has proposed a $7,000 penalty — the maximum allowed by law.
CNN Money: Writer Ivana Kottasova reports that there is currently no country in the whole world where a women makes as much as a man for doing the same job. (Seriously.) In fact, Kottasova writes that the World Economic Forum estimates that it will take another 81 years for the gender wage gap to close. In the U.S., women make about two-thirds of what men make for the same job. Surprisingly, some of the world’s poorer nations are leading the way for pay equality, with the African nation of Burundi taking the top spot.
Minimum wage, paid sick leave on the ballots: Today, residents in a number of states will be casting their votes on minimum wage and paid sick leave initiatives. Read coverage from The New York Times and Boston Globe on what’s at stake.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
Milton “Tito” Rafael Barreto Hernandez, 22, suffered fatal traumatic injuries on Tuesday, October 28, while working for Scott Materials in Scott, Louisiana. KLFY provides some initial information on the worker’s death:
- His employer, Scott Materials, is a “concrete crushing company.”
- A supervisor and another employee were with Hernandez when the accident occurred.
- They were working to remove debris from a conveyor belt on a piece of heavy machinery. The equipment was turned back on and Hernandez was pulled into the machine.
OSHA’s on-line inspection data suggests Scott Materials has not been subject to an OSHA inspection.
Each year, more than 100 workers in Louisiana are fatally injured on-the-job. The Bureau of Labor Statistics reports 114 work-related fatal injuries in Louisiana during 2013 (preliminary data, most recent available.) Nationwide, at least 4,405 workers suffered fatal traumatic injuries in 2013.
The AFL-CIO’s annual Death on the Job report notes:
- Federal OSHA has 16 inspectors in Louisiana to cover more than 103,000 workplaces.
- The average penalty for a serious OSHA violation in Louisiana is $1,765.
Federal OSHA has until the end of April 2015 to issue any citations and penalties related to the incident that stole Tito Hernandez’s life. It’s likely they’ll determine that Hernandez’s death was preventable. It was no “accident.”
Study engages residents in collecting air samples around fracking sites, finds high levels of dangerous chemicals
A recent study of air quality around unconventional oil and gas extraction sites — more commonly referred to as fracking — found high levels of benzene, hydrogen sulfide and formaldehyde, all of which pose risks to human health. But what makes this study particularly interesting is that the air samples were collected by the very people who live near the extraction sites, and the collection times were specifically triggered by the onset of health symptoms.
Published yesterday in the journal Environmental Health, the study involved residents living near 11 unconventional extraction sites in five states: Wyoming, Arkansas, Pennsylvania, Colorado and Ohio. The residents involved in the study were trained to take a “grab air” sample using an inexpensive bucket outfitted with a battery-operated vacuum pump that sucks in air over two to three minutes. (The study authors noted that the bucket device has been subjected to numerous validation tests by public agencies and independent labs.) In addition to the grab air samples, residents were also given a device to measure formaldehyde levels. (That device is called the UMEx100 Passive Sampler and almost looks like an USB flash drive with a clip on it — here’s a picture.) In all, residents put out 41 formaldehyde badges near production facilities and compressor stations.
Residents ended up collecting 35 grab air samples in areas of particular community concern and “under conditions that would lead them to register a complaint with relevant authorities such as a county public health department or state oil and gas commission,” the study stated. Twenty-nine of the samples were taken in direct response to health symptoms, with the most common symptoms being headaches, dizziness, irritated, burning or running nose, nausea, and sore or irritated throat. Air samples were then tested for 74 volatile organic compounds, and formaldehyde samples were analyzed using a method recommended by the U.S. Environmental Protection Agency.
Ultimately, the study found that 16 of the 35 grab air samples and 14 of the 41 formaldehyde tests surpassed minimal risk levels set by EPA and the U.S. Agency for Toxic Substances and Disease Registry, with the three chemicals most commonly found to exceed such levels and which are linked to human disease being benzene, hydrogen sulfide and formaldehyde. Benzene, in particular, was detected at sample locations in Pennsylvania and Wyoming in concentrations that exceeded recommended safe levels “by as many as several orders of magnitude,” wrote the authors, who noted that benzene is a known human carcinogen.
In fact, some air samples had benzene levels that ranged from 35 to 770,000 times higher than background levels (defined as levels that researchers would expect to find naturally), according to a news release about the study. To put that in perspective, the study found benzene levels that were up to 33 times the concentration exposure a person gets when pumping gas. Here’s another comparison from the study’s authors: The benzene exposure a person would experience at one study site in Wyoming would be equal to the exposure of a person living in Los Angeles for two years or Beijing for nearly nine months.
For hydrogen sulfide samples that exceeded recommend levels, study results ranged from 90 to 60,000 times higher than background levels — concentrations that can cause eye and respiratory tract irritation, fatigue, loss of appetite, headache, irritability, poor memory and dizziness. In analyzing the formaldehyde samples that exceeded recommended safe levels, the study found that they were 30 to 240 times higher than background levels. In some cases, the formaldehyde concentrations were more than twice the concentrations found in rooms in which medical students dissect cadavers.
The study authors did note that while the samples taken during the study may reflect a “worst-case concentration,” engaging residents who are directly affected by unconventional oil and gas extraction can benefit long-term research on the topic.
“Community-based monitoring near unconventional oil and gas operations has found dangerous elevations in concentration of hazardous air pollutants under a range of circumstances,” said study author David Carpenter, director of the Institute for Health and the Environment at the University of Albany. “In this study, we have shown that community-based research can improve air quality data while adhering to established methods. Our findings can be used to inform and calibrate state monitoring and research programs.”
To read the full study, visit Environmental 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.
OSHA proposed serious and repeat violations yesterday to Wayne Farms for a variety of safety hazards, including those that led to musculoskeletal injuries among the company’s poultry processing workers. By my calculation, it was the first time in more than a decade that the Labor Department used its “general duty clause” to cite a poultry company for ergonomic hazards.
OSHA conducted the inspection in response to a complaint filed six months ago by the Southern Poverty Law Center on behalf of a group of workers. The complaint described the harsh working conditions in the Jack, Alabama plant, and also provided specifics on management’s retaliation against workers who are injured or complain about hazards. The workers involved in filing the complaint should feel vindicated because OSHA’s citations validate their assertions.
OSHA’s investigation involved staff from its Mobile, Alabama and Atlanta, Georgia offices, as well as the agency’s top-notch ergonomist and occupational medicine physicians. They note that workers in the plant are required to perform:
“prolonged repetitive, forceful tasks, often in awkward postures for extended periods of time.”
Those tasks include cutting wings, cutting shoulders, sawing wins, pulling skin, and pulling tenders.
The OSHA team also identified gross deficiencies in the company’s lockout/tagout procedures. Such safeguards can help to ensure that workers were not caught-in or struck-by equipment when it is being cleaned or repaired. That’s bad enough, but Wayne Farms was cited by OSHA in 2011 for this same violation at one of the company’s other poultry processing plants. For the repeat infraction, OSHA has proposed a $38,500 penalty.
Besides validating the workers’ complaints, OSHA’s citations corroborate what researchers and worker advocates have been saying for decades: Injury rates based on employer self-reporting are works of fiction. OSHA assembled evidence against Wayne Farms on the ways in which the company gamed the system for recording injuries. OSHA’s Mobile, Alabama area director said,
“By failing to report injuries, failing to refer employees to physicians and discouraging employees from seeking medical treatment, Wayne Farms effectively concealed the extent to which these poultry plant workers were suffering work-related injuries and illnesses. And as a result, it reported an artificially lower injury and illness rate.”
I have no doubt that other poultry and meatpacking companies use the same dishonest practices to intentionally deceive the Labor Department and the public about working conditions in their plants. If you haven’t already, you should dismiss any assertions made by the National Chicken Council and other industry groups that poultry slaughtering plants are safe and worker injury rates low. That goes for the safety award given to Wayne Farms in 2011 for its “outstanding safety performance.” The company touts its behavior-based safety program called “WorkSAFE” which
“focuses on helping employees identify unsafe behaviors and remain conscious of their environment and potentially dangerous situations.”
What a bunch of baloney. Workers at Wayne Farms know what causes their injuries. It’s not their “unsafe behaviors.” It’s all about the incessant repetitive motions, fast work pace and deficient equipment in their jobs. These are all things that the company controls, not the workers. The “unsafe behaviors” are the company’s not the workers’.
For me, some of the most powerful language in the OSHA citations is the long list of feasible options the agency offers Wayne Farms to fix the ergonomic hazards. For workers in the chicken deboning area, OSHA explains that the company could:
- increase the recovery of affected body parts through task rotation during the work shift (rotation to tasks without continuous use of a knife, scissors or forceful grip);
- increase recovery time through implementation of mini-breaks, increase cycle time for each task, establish a rotation on a daily basis between departments to increase recovery time (such as rotation between debone and marination);
- provide knives with handles designed for repetitive tasks;
- provide hand tools with textured handles to reduce employee grip force, larger quillons (guard) before the blade to prevent hand from sliding down knife-allowing reduced grip force;
- install mechanical skin removal equipment or provide textured gloves to reduce hand force required in pull skin;
- provide air-assist powered scissors or wing cut;
- position the knife sharpener to minimize non-neutral wrist posture; and
- evaluate employees at each station to determine appropriate work platform height for each employee.
Surely, a firm with more than $1.9 billion in annual sales can afford buying some better hand tools and giving workers rest breaks.
Michelle LaPointe, senior staff attorney with SPLC remarked about the OSHA citations:
“The actions taken by the Occupational Safety and Health Administration go far beyond a company being fined for violations at a single poultry plant,” said Michelle Lapointe, SPLC senior staff attorney. …This is an industry where workers are forced to work at dangerously fast speeds that cause disabling injuries and often thrown away when they can no longer work.”
In a statement to Dave Jamieson of the Huffington Post, Wayne Farms said it is contesting the citations.
OSHA has taken an important step with these citations. It was Labor Secretary Elizabeth Dole in the late 1980’s that put citations for ergonomic hazards on the radar screen. Use of the general duty clause was embraced at the time, but largely abandoned over the last decade. Our government has failed to hold poultry companies accountable for the workplace hazards that cripple the hands, wrists, shoulders and backs of workers. I hope these citations are not an anomaly, but a sign of much more attention to the deplorable working conditions in poultry and meatpacking plants.
Raising the federal minimum wage isn’t only good for workers — it’s good for the federal budget as well, according to a new issue brief from the Economic Policy Institute.
Released earlier this month, the policy brief details just how many low-wage workers have to depend on public assistance programs to make ends meet and how increasing the minimum wage could save billions in federal spending — and those billions could be redirected toward creating stronger, more resilient anti-poverty programs. The brief reports that about half of all workers earning less than $10.10 per hour, the new minimum wage proposed in the federal Fair Minimum Wage Act of 2013, receive public assistance either directly or through a family member via programs such as Medicaid, the Earned Income Tax Credit, the Supplemental Nutrition Assistance Program (also know as SNAP and formerly known as food stamps), the Low Income Home Energy Assistance Program, the Supplemental Nutrition Program for Women, Infants and Children (WIC), the Section 8 Housing Choice Voucher program and the Temporary Assistance for Needy Families program. All of that adds up to more than $45 billion in government assistance each year.
“Essentially, low-wage employers are being subsidized by the taxpayer,” said brief author David Cooper in a news release. “Prices are going up, but paychecks are not, and taxpayers are making up the difference. We’ve long known that raising the minimum wage would help millions of workers and give the economy a boost — now we know it’s a winning idea for taxpayers, too.”
If the minimum wage went up to $10.10, which the federal legislation would do over the span of three years, more than 1.7 million Americans would no longer have to rely on public assistance to meet their basic needs. In fact, the policy brief reported that going up to $10.10 an hour would lower government expenditures by $7.6 billion each year — and that’s a conservative estimate. Overall, safety net programs would save 24 cents for every additional dollar in wages paid to workers who benefit from the minimum wage increase. Right now, accounting for inflation, the current federal minimum wage of $7.25 is about 25 percent less than the minimum wage in 1968. Cooper, an economic analyst, writes:
This failure to adequately raise the wage floor has contributed strongly to the stagnation of wage growth at the bottom of the wage distribution. This wage stagnation has, in turn, been the single greatest impediment to making rapid progress in poverty reduction in recent decades. Indeed, all of the decline in poverty reduction in recent decades can be accounted for by safety net and income-support programs. In fact, managers at some of the largest and most profitable corporations in the United States today actively encourage their employees to seek public assistance to supplement meager paychecks. All of this has led many to conclude that American employers are too often dodging their responsibilities as partners in the social contract — the understanding that Americans who work hard should be paid enough to make ends meet. Instead, too many low-wage employers are leaving both taxpayers and, more importantly, low-wage workers themselves to pick up the slack.
The policy brief examines two methods for estimating how a minimum wage change would affect enrollment in public assistance programs. The first is known as a quasi-experimental design or natural experiment and compares a labor market that did increase the minimum wage to a similar labor market that did not. In this case, Cooper cites a study that examined the effects of a minimum wage increase on SNAP enrollment and spending. That study found that a 10 percent increase in the minimum wage reduced SNAP enrollment by between 2.4 and 3.2 percent and reduced SNAP expenditures by 1.9 percent.
The second research method is known as the simulation method, in which researchers estimate how benefit expenditures would change as hourly wages change, with all else remaining the same. Using this method, Cooper compared the receiving of public assistance among low-wage workers to higher-wage workers and estimated how a raise in the federal minimum wage to $10.10 would affect the use of public assistance programs. He found that increasing the minimum wage would provide about $32 billion in additional wages to more than 27 million workers, which “would unquestionably improve living standards for millions of working families.” He also found that a $1 hourly wage increase would be expected to reduce the average annual benefit dollars received from all safety net programs by $126 per affected worker. In total, a minimum wage raise could save the nation $7.6 billion in safety net spending.
Cooper noted in his conclusion that the safety net programs explored in the brief are critical for struggling families and “if anything, these programs are in need of expansion.” However, he also wrote that it’s time to call on employers to do a better job.
“As American businesses achieve record profit levels, we have to question whether it is appropriate to rely more and more heavily on safety net programs as the sole policy tool to raise working individuals’ incomes or whether we should expect more from the businesses that employ them,” Cooper writes.
To download a full copy of the policy brief, “Raising the Federal Minimum Wage to $10.10 Would Save Safety Net Programs Billions and Help Ensure Businesses are Doing Their Fair Share,” visit the Economic Policy Institute.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.