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
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.
“The incident could have been prevented” – Community frustrations on display at Chemical Safety Board meeting on 2010 Tesoro Anacortes refinery explosion
The city of Anacortes – population about 16,000 – sits on shores of Fidalgo Island, the eastern-most island in the San Juan archipelago, the string of islands clustered off the northwest coast of Washington State. Located at the western end of Skagit County, known regionally for its agriculture, Anacortes’ petrochemical plants – Tesoro and Shell refineries and a chemical plant recently acquired by the Canadian company ChemTrade — together make up the city’s largest single-industry employer. On a rainy January evening, smoke plumes from these plants that sit near the water’s edge merge with low-hanging clouds above the bay.
On April 2, 2010, at 12:30 a.m., a heat exchanger in the Naptha Hydrotreater unit at Tesoro’s Anacortes petroleum refinery ruptured catastrophically, causing an explosion and fire that killed seven Tesoro employees: Daniel J. Aldridge, Matthew C. Bowen, Darrin J. Hoines, Matt Gumbel, Lew Charles Janz, Kathryn Powell, and Donna Van Dreumel. The workers had been in the final stages of preparing to restart the unit’s heat exchangers after several had been shut down for cleaning. The highly flammable hydrogen and naptha that were released at temperatures above 500ºF ignited explosively and burned intensely for more than three hours.
The US Chemical Safety Board (CSB) draft final report investigating the incident, released to the public the evening of January 29, 2014, concludes that several factors set the stage for the disastrous event: severely cracked and degraded equipment that resulted in frequent leaks of flammable liquid and occasional fires; weak industry standards; a deficient refinery safety culture and an inadequate oversight and regulatory system.
Specifically, the CSB investigation found that a type of damage known as High Temperature Hydrogen Attack (HTHA) created cracks and fissures in the heat exchanger’s carbon steel that eventually caused the catastrophic break. The CSB report faults the American Petroleum Institute (API) standards that allowed such equipment to remain in use and notes the technical difficulties of inspecting for HTHA damage. Such inspection is, says the CSB, low in the hierarchy of controls – the tiered priority of safety measures – and that inherently safer design is the best approach to preventing HTHA.
The report also faults Tesoro and the refinery’s previous owner, Shell Oil, for inadequate implementation of safeguards that could have identified hazards and protected against HTHA and subsequent equipment failure. Instead of making changes that would have averted these problems, CSB said the refinery responded to them with procedures that exacerbated the potential for danger. The report additionally points to deficiencies in Washington state’s resources for oversight as well as inadequacies in US federal regulations that allow such problems to persist without correction.
CSB recommendations of what’s needed to prevent such incidents from occurring include: revision of API standards for equipment susceptible to HTHA and requirements for use of inherently safer design; revision of the US Environmental Protection Agency’s (EPA) Chemical Accident Prevention Provisions to require the documented use of inherently safer systems; improved oversight by Washington State and implementation of a process safety culture program at the Tesoro Anacortes Refinery that includes third-party oversight.
“This incident could have been prevented,” said CSB lead investigator Dan Tillema, presenting the report at a public meeting held to present the report in Anacortes on January 30, 2014.
Report finalization postponed
When first announced, the January 30 meeting – held in the Anacortes High School auditorium – was to include a vote by the CSB board that would finalize the CSB report on the incident and the agency’s recommendations to prevent similar problems in the future. But a week before the meeting, the CSB announced that instead of a CSB Board vote on the 30th, the draft final report would be released for a 45-day comment period and the meeting would be a “public listening session.”
While this may seem like an arcane detail, it was clear from the comments voiced by community members in Anacortes on January 30th that they were not happy the that nearly four-year long CBS investigation process would be prolonged.
“I’m very frustrated… by how long it’s taken,” said Steve Garey, machinist and President of United Steelworkers (USW) Local 12-591. According to USW members at the January 30th meeting, the majority of refinery workers in Anacortes are represented by United Steelworkers Local 12-591. “The owner operators have the responsibility to manage a safe workplace…they have that responsibility regardless of how capable the regulators are,” Garey said. “The entire industry is not doing what they should be doing…that’s why we had seven killed at Tesoro, that’s why we had 15 killed at Texas City eight years ago, that’s why we had 11 killed in the Gulf of Mexico…”
“Seven families were devastated,” said Ryan Anderson, a maintenance employee at the Tesoro Anacortes refinery. “Our community was devastated. For almost four years we’ve waited for a final CSB report. We’re still waiting,” he said.
USW safety and health specialist Kim Nibarger, who came from Pittsburgh to attend the meeting, called the change “troubling.”
In their remarks, USW and other community members asked CSB to return to Ancortes to hold the final vote on the investigation report. CSB director Rafael Moure-Eraso made no promises but explained that all public comments would be taken into consideration, and would be used to improve the report before it is finalized. “You are the most important stakeholders,” he told those gathered in Anacortes on January 30th.
Worth noting is that the CSB, the independent federal agency tasked with investigating industrial chemical accidents, is chronically under-resourced. As West Virginia Senator Jay Rockefeller noted in a press release issued as the CSB began to investigate the January 2014 Freedom Industries chemical leak, “the agency’s proposed 2014 budget was slashed by the Republican-controlled House of Representatives earlier this year,” cutting nearly $2 million from the CSB’s roughly $11 million budget. The CSB currently has more than a dozen investigations underway and a staff of about 40.
Ongoing safety concerns
Until the report is finalized, the CSB’s recommendations are also not final. If implemented, those in the Tesoro Anacortes report could make significant improvements in refinery safety, not just at the Tesoro facility but at refineries across the country. As many who spoke in Anacortes on the night of January 30th made clear – as does the CSB report – without these changes, workers at refineries nationwide may well be working under conditions with hazards similar to those present at the Tesoro Anacortes refinery on April 2, 2010.
“We’re still getting hurt out there,” said Maria Howling Wolf, a Tesoro Anacortes employee who vividly recounted the day of the catastrophe as it unfolded.
Families of six of the workers killed brought a wrongful death suit against Tesoro and the Shell Oil Company, the previous owner of the Tesoro refinery, that was settled in December 2013 for a reported $39 million. Tesoro has also been fined a record $2.39 million by the Washington Department of Labor and Industries, which cited Tesoro for 39 “willful” and five “serious” violations of state health and safety standards. Tesoro is appealing the Washington state fine and has, in a preliminary ruling, been granted a judgment potentially reducing the $2.39 million fine to $858,500. A previous OSHA investigation opened in 2008 found 17 serious violations but in negotiations 14 were “deleted” and the penalty fine reduced from $85,700 to $12,250.
Speaking at the January 30th meeting, API representative David Miller said his industry is “committed to continuous improvement” and has a “long history of safe operation” and that “no incident is acceptable.”
Tesoro said in a statement sent the next day: “Tesoro deeply regrets the incident of that day. Our thoughts and prayers remain with the families and friends of our seven co-workers who lost their lives.” Tesoro said the company “acknowledges the efforts of the CSB investigation teams” but said, “We respectfully disagree with several findings in the draft report and, most importantly, take exception to CSB’s inaccurate depiction of our process safety culture. However, despite any disagreements regarding the draft report, Tesoro anticipates discussing the CSB’s recommendations with the agency once the report is finalized and will consider them in light of the steps we have taken and are continuing to take to improve the safety of our facilities.”
Speaking after the meeting, USW member Gaylen Prescott expressed concern about ongoing management pressure to keep the employee numbers down and resulting work loads and hours that can erode workplace safety. “We relied on hope and luck,” said USW Local 12-591 member George Welch in his comment for the record.
Toward the end of the January 30th meeting’s public comment period, an older man stood to speak. “My name is Eustus Ken Powell,” he said. “My daughter was one of the ones who was killed …my life was forever changed.”
The draft final CSB report is open for comment until March 16, 2014.
Elizabeth Grossman is the author of Chasing Molecules: Poisonous Products, Human Health, and the Promise of Green Chemistry, High Tech Trash: Digital Devices, Hidden Toxics, and Human Health, and other books. Her work has appeared in a variety of publications including Scientific American, Yale e360, Environmental Health Perspectives, Ensia, The Washington Post, Salon and The Nation.
MSHA recently issued two fatality investigation reports for incidents at quarries involving haulage trucks. Both incidents, one in Missouri and the other in Pennsylvania, occurred in September 2013. The reports caught my attention in particular because both include this statement:
“Additionally, he was not wearing a seat belt and was ejected from the haul truck which contributed to the severity of his injuries.”
What do we know, or not know, about why some workers fail to wear their seatbelts?
First, here are a few details about the fatalities:
One involved a 1980 Caterpillar 773B haul truck. The driver, David A. Gully, 58, was traveling from the pit of a quarry up an unpaved haulage road with an 8 percent grade. The berm along the roadway consisted only of large boulders spaced 4-5 feet apart. When the truck maneuvered too far to the left, the berm was inadequate to prevent the vehicle from plummeting hundreds of feet over a highwall. (I’ll set aside my question about why the MSHA inspection, just a month earlier, did not identify the inadequate berm.)
The other involved a 1983 Jeep M35A2 cargo truck. Timothy Farr, 31, was using the truck to haul four 250-gallon water containers. He maneuvered the vehicle up the unpaved roadway, which had a 25 percent grade and three switchbacks. One of the containers fell off the truck, the load shifted, and the truck’s wheels lost traction. The vehicle moved backwards, the remaining water containers shifted and the truck overturned. The investigators found that the brakes on the truck had not been maintained and the containers had not been secured on the truck.
No one knows with certainty whether the workers would have survived these incidents had they been wearing their seatbelts. MSHA’s statement “contributed to the severity of his injuries” suggest that might be the case. So why don’t some workers wear their seatbelts?
A study by Kim and Yamashita, published in 2007 in Accident Analysis & Prevention identified two key reasons given by 791 commercial drivers in Hawaii for not consistently wearing a seatbelt: (1) they are uncomfortable, and (2) they are inconvenient for drivers who have to make frequent stops (e.g., to make deliveries.)
A study by Schlundt and colleagues examined the relationship between BMI and seatbelt use. They reported a decrease in seatbelt use as the BMI of drivers increased. They found this trend for all age groups, except among 16-24 year olds.
I few years back another fatality investigation report prepared by MSHA caught my attention. It also involved a worker who did not wear his seatbelt. Robert C. Stewart, 28, was killed in September 2009 at ASARCO’s Ray (copper) mine in Gila County, Arizona. He was operating a 1997 Komatsu 830E dump truck when it struck a berm. When the truck overturned, Stewart fell from the cab and suffered fatal injuries. Like the two cases above, MSHA’s fatality investigation report indicated that failure to wear a seatbelt “contributed to the severity of his injuries.” I wondered why Mr. Stewart was not wearing the seatbelt. I considered reasons such as the following:
- Was the window on the cab open (that he fell from) because the air conditioning on the truck wasn’t working? MSHA’s report notes it was 80 degrees outside.
- The cab of the truck is about 20 feet off the ground. These monster trucks can have poor visibility. Without blind-spot cameras, did he need to remove his seatbelt in order to see out and around the truck and the roadway?
After near-miss incidents and work-related fatalities occur, investigators typically focus on the “cause” of the incident: Was the equipment not maintained? Were operating procedures inadequate? Had safety equipment been tampered?
But if investigators really want to get to the bottom of what happened, they also need to ask “but why?” But why was the equipment not maintained? But why has the safety equipment been tampered?
In the three fatal work-related injuries noted above, the victims were not wearing their seatbelts. MSHA concluded that this fact contributed to the severity of their injuries. But why weren’t they wearing them?
- If a worker is too large for the manufactured installed seatbelt, was a belt extender provided?
- If a worker finds the seatbelt is uncomfortable or slows them down from getting their deliveries made on time, could the worker and his employer figure out a way to remedy the situation so the seatbelt is worn dutifully?
- If the two-story high haulage truck has blind spots and the worker needs to unbuckle his seatbelt to see what’s around him, could visibility cameras be installed to rectify the problem?
- Is there simply a segment of the population who are stubborn and won’t wear a seatbelt no matter what intervention is tried?
When I read fatality investigation reports and I learn that the driver wasn’t wearing a seatbelt, my first reaction is often: “Really? No seatbelt?” But I also know that we certainly should do more to find out why some workers don’t wear them. I’d like to see us asking that now, rather than wondering why after the worker is dead.
In a first-of-its-kind study, a researcher has estimated that the health-related economic savings of removing bisphenol A from our food supply is a whopping $1.74 billion annually. And that’s a conservative estimate.
“This study is a case in point of the economic burden borne by society due to the failure to regulate environmental chemicals in a proactive way,” study author Leonardo Trasande told me.
With evidence mounting that bisphenol A (BPA) exposure is a serious health risk, Trasande, an associate professor in pediatrics, environmental medicine and health policy at New York University, wanted to examine the economic trade-offs of replacing BPA with a safer alternative. BPA, a synthetic compound used in plastics and found in the lining of food and beverage containers, has been identified as an endocrine disruptor and linked to cancer, asthma, fertility outcomes, adverse neurobehavioral development, obesity promotion and cardiovascular risks.
While the U.S. Food and Drug Administration has banned the chemical in baby bottles and sippy cups, it’s still used in food cans and drink packaging. According to Trasande’s study, which was published in the February issue of Health Affairs, more than a million pounds of BPA is produced every year. The chemical is so common that “exposure to BPA in the United States is nearly ubiquitous: In a nationally representative sample, 92.6 percent of people ages six and older had detectable BPA in their urine,” he wrote. Trasande also cited a 2011 study that found that eating one serving of canned soup a day over five days was associated with a more than 1000 percent increase in urinary BPA.
To uncover the economic benefit of replacing BPA, Trasande zeroed in on the social costs of childhood obesity and adult coronary heart disease attributable to food-related BPA exposure in the United States in 2008. Based on BPA research findings, he estimated that BPA exposure was associated with 12,404 cases of childhood obesity and more than 33,800 cases of new coronary heart disease that year, totaling $2.98 billion in social costs. Removing BPA from food packaging, the study estimated, could prevent about 6,200 cases of childhood obesity and 22,350 cases of coronary heart disease each year, totaling an economic yearly benefit of $1.74 billion.
Also, of the 12,404 obese children, more than 9,400 were estimated to remain obese into adulthood, which creates an additional $489 million in health care costs and $972 million in lost quality-adjusted life years, which is way of measuring the impact of disease burden. In all, $2.98 billion in annual costs are attributable to BPA-related childhood obesity and heart disease.
Trasande’s study also weighed the cost savings of removing BPA from food items against the cost of replacing the chemical with oleoresin, a plant-based mixture of oil and resin that might be safer than BPA. He found that replacing BPA in aluminum cans would cost about $2.2 billion each year, which would be borne by manufacturers and consumers via higher prices, “whereas the costs of obesity and coronary heart disease attributable to BPA are borne by multiple sectors of society.” Trasande emphasized that premarket testing of a BPA substitute is necessary to avoid additional, or even worse, health outcomes. He wrote:
Newer economic models are also needed to account for uncertainty in disease causation, so that trade-offs involved in decisions such as whether to remove BPA from food uses can be weighed more carefully in spite of incomplete understanding of the health consequences. These newer approaches will be especially important in informing regulations of endocrine-disrupting chemicals. Information on the costs of their ongoing use, however incomplete, is needed because of the broad public health effects of these chemicals.
Unfortunately, the true economic health cost of BPA is probably much higher, Trasande said, as his study only examined two of the health impacts to which BPA has been linked.
“Our findings suggest that further regulation by FDA may produce substantial economic benefits to society,” he told me. “In addition to promoting diet and behavioral change, which can be difficult to implement and make persistent, regulatory action can be done by government agencies without much in the way of additional economic investment.”
Right now, FDA considers BPA safe at the “very low levels that occur in some foods,” though Trasande noted that the assumed safety threshold for BPA has not been documented in any study. The agency has initiated a number of studies examining the safety of BPA, but it’s hard to say if FDA even has all the information it needs to really determine safe exposure levels. According to FDA’s own website, “today there exist hundreds of different formulations for BPA-containing epoxy linings, which have varying characteristics. As currently regulated, manufacturers are not required to disclose to FDA the existence or nature of these formulations.” (Just this month across the proverbial pond, the European Food Safety Authority recommended lowering current tolerable daily intakes of BPA.)
Trasande said the findings of his study weren’t surprising considering the costs of child obesity and cardiovascular disease, “but what is surprising is to hear the counter-arguments that replacing BPA could introduce increases in food-borne illnesses, which is simply not true. …that’s an unscientific claim.” (That food-borne illness argument is from the North American Metal Packaging Alliance, which addressed Trasande’s study in a Jan. 23 news release.)
While policy changes would have the biggest impact on BPA exposure, people can take individual action, too. Trasande noted that some studies have suggested that eliminating aluminum canned-food in favor of fresh food can reduce urinary BPA levels between 66 and 92 percent. He said that while many factors contribute to childhood obesity and cardiovascular disease, stricter BPA regulation could offer the opportunity for “rapid and substantial reductions” in disease burden.
“There is great potential for health benefits through changing behaviors to reduce ongoing BPA exposure,” Trasande said. “But it may actually be quite beneficial to society to replace BPA and institute a more pervasive ban on its use in foods.”
To read Trasande’s full BPA study, visit Health Affairs.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.