Following the deadly April 17, 2013 explosion at the West, Texas West Fertilizer Company plant that killed fifteen people and injured hundreds – and a series of other catastrophic incidents involving hazardous materials – President Obama issued Executive Order 13650. It directed federal agencies to improve the safety and security of chemical facilities to reduce risks to workers, communities and first responders. To do so it established a working group, led by the Department of Labor, Environmental Protection Agency (EPA) and Department of Homeland Security, that would report back to the President with recommendations for improving policies, practices and coordination between industry, state, local, federal, other authorities as well as community and other public interest groups. That report, Actions to Improve Chemical Facility Safety and Security – A Shared Commitment, was released on June 6th.
Produced with input from “listening sessions” and public comment from nearly 1,800 people in more than 25 states, the report calls for stronger community preparedness, better information about chemical hazards, and for improved risk management and safety procedures at facilities that use and store hazardous chemicals. It calls for establishment of a Chemical Facility Safety and Security National Working Group to improve coordination between federal agencies, and it summarizes what’s been done since EO 13650 was issued in August 2013. Steps taken over the preceding months include guidance from EPA, Occupational Safety and Health Administration (OSHA) and industry groups on the use of ammonium nitrate, the chemical involved in the West, Texas disaster. What it does not do is set forth any new requirements for facilities where hazardous chemicals are used. Instead it sets the stage for possible future rule-making that would create enforceable regulations around safer chemical management practices.
“It’s a good document at looking at what they can do,” said Houston-based, Texas Environmental Justice Advocacy Services (TEJAS) director Juan Parras in an interview. “But a lot would be based on a voluntary system. We were looking for harder words, such as ‘mandate,’” he said. “We’re grateful for work that’s moving in the direction of addressing chemical security of vulnerable populations,” said Parras. But “volunteering is just not good enough.”
Parras expressed particular concern for communities like those he works with in the Houston area that live near not just one but many refineries and chemical plants. The federal report does reflect such concerns, saying, “Communities need to know where hazardous chemicals are used and stored, how to assess the risks associated with those chemicals, and how to ensure community preparedness for incidents that may occur.”
The report also notes that in its outreach to around the country, “Community members expressed concern about a perceived lack of effective communication from industry partners regarding incidents and general facility safety and performance.” There was particular concern, says the report, about how low-income and other vulnerable individuals would be protected in the event of a disaster. “Communities adjacent to multiple facilities,” – such as those represented by TEJAS – “also raised concerns regarding the failure to address the specific vulnerabilities of lower-income communities, including environmental justice considerations.”
“It’s clear that the Working Group listened to the voices of the communities and workers most at risk of chemical disasters.There are recommendations in their report that can help prevent disasters if they are enacted. But words are not enough. The Administration now has to turn these words into actions,” said Richard Moore, co-coordinator of the Environmental Justice Health Alliance for Chemical Policy Reform and former Chair of EPA’s National Environmental Justice Advisory Council.
“Not an endpoint”
The agencies releasing the report – the Department of Homeland Security, EPA and OSHA – stress in an accompanying blog post that the “report is a milestone, not an endpoint,” and that while it “describes many activities already undertaken to improve chemical facility safety and security, it also makes clear that much additional work is necessary to implement the consolidated action plan.”
Asked how each agency plans to work toward implementing the report’s recommendations, EPA and OSHA provided identical responses via email. Both statements said, “the Administration supports, where feasible, using safer technology to enhance the security of the nation’s high-risk chemical facilities” and that the “Working Group will address the use of safer technology and alternatives by encouraging the use of a holistic approach to identifying hazards and reducing risk using a hierarchy of controls to guide the analysis.” Both also said “OSHA and EPA will consider requirements to incorporate safer technologies or process safety alternatives into the facility process hazard analysis although they will not direct what technologies or process safety alternatives need to be used by facilities.”
Risk reduction “has already occurred organically under the Chemical Facilities Anti-Terrorism Standards (CFATS), “as companies review their chemical processes and security practices and industry is taking upon itself to use safer alternatives,” said EPA and OSHA in these statements.
What EPA and OSHA are referring to are the changes made by many water treatment plants – and other facilities – to increase security by eliminating or reducing on-site storage of chlorine (a potential explosive), among other chemical hazards after 9/11.
“Instead of the voluntary inherently safer technology (IST) initiatives described in this report the White House should give the EPA a green light to pursue IST requirements that eliminate catastrophic hazards the way Clorox did and hundreds of other plants have done including the Washington, DC waster water plant which converted in 90 days after the 9/11 attacks. Clorox’s 5 plants eliminated this risk to 13 million people and DC eliminated a similar risk to 1.7 million people including the Capitol building and White House,” said Rick Hind, Legislative Director of Greenpeace’s Toxics Campaign.
Charlotte Brody, Vice President for Health Initiatives with the BlueGreen Alliance, a coalition of environmental and labor groups, also points to 9/11 as a turning point in galvanizing awareness of the role of safer technologies – safer materials, fewer chemical hazards – in protecting not only communities but also first responders. Elevated cancer rates among World Trade Center first responders and firefighters elsewhere, including San Francisco, says Brody, “has increased the recognition that we make stuff that when it burns makes firefighters sick.”
The federal report, said Brody, presents opportunities to organize concerted efforts around improving specific aspects of chemical safety – such as moving away from the use of the extremely hazardous chemical hydrogen fluoride that used as a catalyst in numerous chemical manufacturing processes – and by looking to other industries’ models – such as that the airlines use – for implementing safety improvements. But she says, voluntary efforts will only go so far, and “regulatory reform is needed to lift the bottom.”
What’s expected next from the Administration is an “alert” from EPA and OSHA, “followed by guidance to promote the use of safer alternatives and technology” and possible rule-making to revise “process safety management” and “risk management plan” standards. “The agencies’ ultimate coverage of safer alternatives will depend on the outcome of the regulatory process,” said OSHA via email.
Chemicals continue to endanger workers and communities
Meanwhile on June 9, workers at a Koch Foods chicken processing plant in Gainesville, Georgia were evacuated and four were hospitalized following an ammonia leak. On June 7, an ammonia leak at a Farmland Foods pork processing plant in Wichita, Kansas caused three injuries, including one reported as “serious,” and evacuation of the plant. Two days earlier, a chlorine vapor leak from a BNSF tank car in Lafayette, Louisiana prompted the evacuation of two nearby businesses and prompted questions about local air quality, including whether or not area residents could safely use their air conditioners. The same day, in Bristol, Virginia, an uncontrolled chemical reaction in a Strongwell Corporation plant’s resin room (the company manufactures building components) caused one worker to be hospitalized, exposed several others who went through a decontamination process, and prompted evacuation of the premises.
“When another chemical disaster occurs, the question that will be asked is: why wasn’t this prevented,” says Rick Hind.
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.
Getting to the truth about the 2010 Upper Big Branch disaster (UBB) is what they wanted. The families of the 29 coal miners who were killed in the Massey Energy coal mine in Raleigh County, WV looked to the investigators for the answers. Jim Beck was instrumental in providing them those answers. Beck was part of the six-person Governor’s Independent Investigation Panel, and he was a key player in finding out the truth. Jim Beck died last week at age 61 from metastatic stomach cancer.
“Jim and his team gave me and the other 28 families of UBB the truth of what happened to our loved ones,” remembered Betty Harrah. Her brother, Steven “Smiley” Harrah, 40, was one of the miners who died in the massive coal mine dust explosion.
Beck served as the team’s key investigator at the scene of the crime, spending hundreds of hours in the coal mine with the federal and state inspectors. No one could accuse him of “just tagging along” in the effort. As a former coal miner, foreman, superintendent, and CEO of a major coal mining company, he knew what to look for and the questions to ask.
I’d not worked with Jim Beck prior to our involvement in the UBB investigation. I appreciated his patience, especially when I asked him questions about particular mining practice or needed help reading the mine map. He was masterful at explaining things to those of us who were not coal miners. I also respected his integrity. Late in his mining career, Beck lost a job with a mining company for refusing to compromise on safety.
Davitt McAteer, who led the Governor’s team, recalled one moment he shared with Beck during the UBB investigation:
“We were underground on the longwall, near the place where the longwall miners were found. He and I sat there for some time absorbed in our own thoughts. It was absolutely quiet and black but for our cap lamps. The other investigators had gone ahead of us. Jim said, ‘it doesn’t have to be this way. They didn’t have to die….’”
Jim Beck will be missed.
One of the things policy wonks are keeping an eye on as the Affordable Care Act is fully implemented is the proportion of employers who stop offering employees insurance and instead give their workers money they can use to pay premiums of plans sold on health insurance exchanges (or marketplaces). As Robert Pear reports in the New York Times, though, a new IRS ruling will discourage employers from doing that. The IRS will not consider employer arrangements that give workers premium funds (for purchasing insurance through exchanges) to satisfy the ACA requirements, which means employers could be subject to fines of up to $36,500 per employee per year.
This reminds us of an important question: Do we want to encourage employers to continue to be the major source of health-insurance coverage for the US’s non-elderly population? In 2012, 56% of US residents ages 0-64 had insurance coverage through an employer.
On the whole, I’d like to see our country move away from our reliance on employer-sponsored insurance, because it leaves some kinds of workers at a disadvantage and while creating difficulties for those who contemplate job changes. Some workers can’t get coverage through their employers (e.g., low-wage workers in small firms are less likely to have employer-sponsored insurance than higher-paid workers and those employed by large firms), and those those who want to freelance, start their own businesses, or work for small organizations often face less-attractive options, with higher premiums, more cost-sharing, less-generous benefits, or all of the above. Employees who have good employer coverage may be reluctant to strike out on their own or change jobs if they like their current health insurance, and that can make it harder for new graduates or others seeking new or different jobs to find employment. Even workers who change from one employer’s plan to another that’s equally generous can face headaches when switching to another insurer’s network and practices.
Offering health insurance can be a headache for employers, too. I worked for several years at a medium-sized nonprofit, and a great deal of staff time was devoted to insurance issues. Many organizations would probably rather focus on their core missions or businesses rather than developing expertise in local health-insurance options. And there’s also the fact that, especially for smaller employers, having one or two employees with cancer diagnoses, severe trauma, or other costly diagnoses in a single year can lead to huge premium hikes. Employers who make difficult tradeoffs between benefit generosity and affordability to workers can face criticism on either side.
From the employer perspective, though, there are also reasons why it makes sense to offer health insurance. Such benefits can help attract and retain employees, and they also come with tax savings. Employer-sponsored health benefits aren’t taxed the way ordinary income is, so employers who pay a portion of workers’ premiums as part of an overall compensation package and workers who get such coverage get payroll- and income-tax savings not available to most individuals puchasing plans on the private market (premiums for privately purchased insurance are tax-deductible only for those who itemize deductions and have medical expenses exceeding 10% of their income).
Shifting away from a reliance on employer-sponsored insurance would level the playing field between different kinds of workers and employers, and reduce some of the job lock and headaches that can occur for workers who have good employer coverage. One down side of having more people buy their plans from exchanges, though, is that it will mean higher costs for some individuals.
The Affordable Care Act prohibits plans from excluding or charging higher premiums to applicants who are women or who have pre-existing health conditions (things that made individual plans unavailable or unaffordable to many in the pre-ACA days). Plans sold on health-insurance exchanges are allowed to charge higher premiums to older adults and to smokers, though — up to three times more to older applicants and up to 50% more to smokers. So, middle-aged and older employees and those who smoke would likely be facing higher premiums than they do under employer-sponsored plans. Even if they received higher wages from employers no longer providing insurance, these individuals still might struggle to afford premiums for individual policies. Sliding-scale subsidies are designed to make plans affordable for those with incomes between 100% and 400% of the federal poverty limit, but there can be a gap between what the government defines as affordable and what a family considers affordable.
Some people with incomes above 400% FPL ($62,920 for a two-person household, $95,400 for four) might find it difficult to switch from employer-sponsored to individual-market plans, too. For instance, a household of two 60-year-olds making $65,000 per year would need to pay more than $1,100 a month (over $13,200 a year) to get a silver-level plan that covers both of them in Fairfax County, Virginia. (You can try results for different ages and locations here.)
It makes sense that the Obama administration would want to adopt policies that discourage employers from dropping their insurance plans and sending their workers to the exchanges to buy health insurance. Older employees suddenly faced with the need to buy individual policies would likely find their premiums to be significantly higher, and in some cases would consider them unaffordable. (Conversely, younger workers might find them lower.) We might want a system that doesn’t rely on employer-sponsored insurance, but the transition will be challenging.
Back in 2009, Atul Gawande wrote a great New Yorker piece about how different countries’ healthcare systems have evolved. He noted that the US reliance on employer-sponsored insurance sprang from employers’ use of insurance benefits as a way to get around post-war wage controls set by the Roosevelt Administration, and warned that it would not be easy to shift from this path to one with little or no role for employers. Gawande also offered some optimism, though. He pointed to Massachusetts’ health insurance reform, upon which the ACA was modeled, as something that is far from perfect but that the vast majority of people still consider to be an improvement.
We won’t be able to fix everything in our system at once. Some people will still stay in jobs that aren’t right for them because they feel they need the health benefits, but at least they know that they’ll have an option to buy insurance on the individual market if they’re laid off or decide to freelance. Before the ACA, a 60-year-old with a chronic health condition or two would struggle to find any insurer to sell her an individual plan, let alone a plan with a premium of under $600 a month. As we grapple with ongoing issues of affordability, quality, and access, we need to keep in mind what we want our healthcare system to look like a generation from now.
Five million dollars. That’s how much the fast food industry spends every day to peddle largely unhealthy foods to children. And because studies have found that exposure to food marketing does indeed make kids want to eat more, advertising is often tapped as an obvious way to address child obesity. Fortunately, a new study finds that the public agrees.
As part of the Los Angeles County Health Survey, researchers with the Los Angeles County Department of Public Health asked nearly 1,000 adults four food policy questions: would they support a tax increase on sodas to discourage kids from drinking too many; should sugary cereal, candy, soda and fast food advertising aimed at kids be restricted; should there be a law prohibiting fast food restaurants within a quarter-mile of schools; and should convenience stores be legally prohibited from setting up shop within a quarter-mile of schools.
The results, which were published in the June 5 issue of Preventing Chronic Disease, found that marketing restrictions garnered the most support, followed by a soda tax and zoning restrictions. Specifically, 74 percent of respondents supported advertising restrictions, 60 percent supported the soda tax, and 44 percent and 37, respectively, supported zoning restrictions for fast food restaurants and convenience stores. While support for the tax and zoning policies varied among different demographic groups, the marketing restriction scored high levels of support across all groups.
As policy interventions go, the researchers noted that support for a soda tax, which lost at the ballot box in California in 2012, might not hold up in the face of industry opposition. Also, low support for zoning restrictions might make that policy intervention a difficult sell and would do little for communities in which fast food restaurants and schools are already situated near each other. Study authors Paul Simon, Choiyuk Chiang, Amy Lightstone and Margaret Shih write:
Although there are legal considerations in pursuing public policy that would regulate food and beverage marketing to children, our results suggest that such efforts would receive support. This support may help persuade private companies to self-regulate. There may also be opportunities to expand advertising restrictions in public schools and publicly regulated child care settings. For example, the White House and U.S. Department of Agriculture recently announced proposed federal restrictions on unhealthy food and beverage advertising in public schools.
In related study news, researchers at Stanford University and the University of California-San Francisco found that prohibiting the use of food assistance dollars to buy sugar-sweetened beverages could significantly reduce obesity and type 2 diabetes among adults. To conduct the study, which was published this week in Health Affairs, researchers examined data on more than 19,000 people participating in the Supplemental Nutrition Assistance Program, formerly known as food stamps. The study noted that low-income populations, including people in the SNAP program, experience higher rates of type 2 diabetes and obesity. Also, SNAP participants consume almost twice as many calories from sugary beverages as they do from fruits and veggies.
The study found that instituting a SNAP policy banning the purchase of sugar-sweetened beverages would result in a 15.4 percent decline in calorie consumption linked to such beverages. (Note: This finding takes into account the possibility that SNAP participants might use non-SNAP dollars to buy sugary beverages instead.) Over 10 years, the lower calorie consumption would translate into a 2.4 percent decline in current obesity prevalence rates among SNAP participants, with the biggest effect among adults ages 18 to 65. In addition, researchers estimated that incidence of type 2 diabetes among SNAP enrollees would decline by 1.7 percent or about 240,000 people, with the biggest effect among adults. Authors Sanjay Basu, Hilary Kessler Seligman, Christopher Gardner and Jay Bhattacharya write:
Our study is also the first analysis, to our knowledge, to examine specifically how population-level health outcomes may be altered by fiscal policies directed through SNAP. This subject is of major national interest given that the program is taxpayer funded. The logic behind SNAP policy changes is that taxpayers are potentially subsidizing unhealthy food consumption and paying for its downstream health consequences.
In addition to examining a ban on sugary beverage purchases, the Health Affairs study also looked at whether incentivizing fruit and veggie consumption would impact obesity and diabetes prevalence. Specifically, would giving SNAP participants 30 cents back for every dollar they spend on fruits and vegetables make a difference? They estimated that while the subsidy policy wouldn’t have a significant impact on the two diseases, it could more than double the proportion of SNAP enrollees who meet federal fruit and vegetable consumption recommendations.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
Chris Williamson, 39, was electrocuted on Thursday, June 5 while making repairs to restore electrical service in the City of Florence, Alabama. Williamson worked for the city’s Electricity Department. Tom Smith with TimesDaily.com provides some initial information about the lineman’s death:
- A storm earlier in the day caused a tree to fall on an electrical line in the Hickory Hills area of Florence.
- Mayor Mickey Haddock said tree crews were dispatched to the scene to clear the fallen tree debris. Williamson was called upon to isolate the damaged line from the main feed.
- Williamson was working by himself, climbed the pole, and came in contact with a 7,200-volt line.
- Williamson worked for the City of Florence since 1993. He became a journeyman lineman in 2008. His obituary notes he was a member of IBEW Local #558.
Federal OSHA will not be investigating the death of Chris Williamson. The agency does not have authority to investigate work-related fatalities (or conduct any inspections for that matter) involving state, local or other public sector employees. There are about 305,000 government workers in Alabama who are not covered by the OSH Act. Nationwide, 8 million public sector workers fall outside of OSHA’s scope.
Each year in the U.S., hundreds of non-military public sector workers die from traumatic work-related injuries. In 2012, there were 453 deaths among these workers, including 256 involving local government employees. Ten of them worked in Alabama.
by Rajiv Bhatia, M.D.
Over the past three decades, real wages for low-income workers in the United States have either stagnated or declined. The federal minimum wage is intended to maintain a decent standard of living, but has fallen woefully behind. The current federal minimum of $7.25 an hour is now worth less than it was in 1968.
Evidence from decades of research has convinced many public health professionals that there is no single factor more important to healthy living than a minimum standard of income and no single factor more harmful to health than persistent poverty. Income affects health not only through one’s ability to meet material needs, but also through access to health care, the quality of neighborhoods in which people can afford to live, child health and development, chronic stress, and interpersonal relationships.
Armed with this knowledge, health professionals should be at the forefront of campaigns for raising the minimum wage.
Dr. Edward P. Ehlinger, commissioner of the Minnesota Department of Health, wrote in a recent commentary:
When people think about minimum wage, they most often think about the impact on their bank account and their job. But policies that impact employment and income are actually about health – the health of individuals, families and communities.
Legislation currently in Congress would raise the current federal minimum to $10.10 an hour and then index it to the Consumer Price Index. A $10.10 minimum wage would benefit about 16.5 million workers and raise almost 1 million people over the federal poverty line.
Not waiting for Congress, states are also taking or considering action. In 2014, legislatures in 34 states have proposed increases to the state minimum wage. Connecticut, Delaware, Hawaii, Maryland, Michigan, Minnesota, and West Virginia and the District of Columbia have already enacted increases.
In May, Human Impact Partners and the Health Officers Association of California released Health Impacts of Raising California’s Minimum Wage, intended to inform the consideration of legislation that would raise the state’s minimum wage to $13 an hour by 2017.
Our most dramatic finding is that a $13 minimum wage would avert an estimated 389 premature deaths of low-income Californians a year. An analysis of the California Health Interview Survey, the nation’s largest health survey, also found:
- Californians in families whose income increased as a result of the higher minimum wage would be more likely to be born healthier, develop stronger bodies and brains, and suffer from fewer chronic diseases as adults and into old age.
- Fewer Californians would live in poverty, ensuring that they would get enough to eat. Fewer would be forced to live in the unhealthy environments of substandard housing and poor neighborhoods. More Californians would have adequate health care and access to health insurance.
- More of California’s children would be well prepared for school and achieve more in school, which in itself leads to healthier adult lives. Children would miss fewer school days.
- Fewer people would smoke. In California, adults in families in poverty are 50% more likely to smoke than those in families earning more than three times the poverty level.
- More would exercise regularly and fewer would be obese or overweight. In California, teens in families living below the poverty level are 2.5 times as likely to be overweight or obese as teens in families whose incomes are at least three times the poverty level.
- Fewer Californians would suffer from emotional and psychological problems, such as depression and poor self-esteem. Families who live in poverty are over twice as likely to face serious psychological distress and to suffer from family life impairment as those in higher income families.
A decent standard of living is a powerful prescription for public health. The voices of the health community can help get this prescription filled.
Rajiv Bhatia, M.D., is a founder and board member of Human Impact Partners, an Oakland, Calif., nonprofit that studies the health and equity impacts of public policy. He is the former director of environmental health for the City and County of San Francisco and currently a visiting scholar at the University of California at Berkeley.
Researcher Christopher Wildeman has spent his whole career describing and quantifying the more unpleasant parts of people’s lives and his latest study on the surprising prevalence of childhood maltreatment is no exception. Still, there is a bit of a silver lining, he told me.
“This is the sort of issue that both the right and left shouldn’t have a hard time supporting,” said Wildeman, an assistant professor of sociology at Yale University. “It’s the sort of thing that once we become more aware of it, designing interventions that could diminish maltreatment rates is something anyone can get behind.”
According to Wildeman and his study colleagues, one in eight U.S. children will experience confirmed maltreatment by the time they turn 18 years old. The term “child maltreatment” includes neglect as well as physical, sexual or emotional abuse. The finding, which is greater than other maltreatment estimates, was published earlier this week in JAMA Pediatrics. To calculate the one-in-eight finding, researchers examined eight years of official data on confirmed maltreatment cases from the National Child Abuse and Neglect Data System.
Specifically, researchers wanted to get at the cumulative effect of confirmed maltreatment cases, so they took the same approach that the Census uses to calculate life expectancy at birth. That method essentially asks this question: Starting at birth, if a person is exposed to the latest age-specific mortality rates, how old can we expect that person to be when she or he dies? Similarly, Wildeman and colleagues asked what would happen if a hypothetical child is exposed to age-specific, confirmed initial maltreatment rates from 2004 through 2011. Based on that data, what proportion of children could ever expect to experience maltreatment? The answer is one in eight — a prevalence that’s nearly 14 times higher than the confirmed annual child maltreatment caseload.
Wildeman noted that about three-quarters of the data used in the study concerned cases of neglect. He also emphasized that for child protective officials to confirm a case of neglect, the neglect is highly chronic or very severe, such as a 7-year-old left alone to care for younger siblings or a child showing up at school malnourished.
“(This finding) alerts the American public to the fact that child maltreatment is a pressing social problem on the same scale as a whole host of other childhood experiences that we pay so much attention to,” Wildeman told me. “In my mind, it seems like an obvious underestimate…but let’s just say that even if this is the absolute floor — that one in eight children experience maltreatment — it’s just tragic how few resources we give to preventing maltreatment. It’s kind of amazing that we basically ignore this topic.”
Typically, there are two types of child maltreatment estimates. The first are annual estimates of confirmed cases from Child Protective Services. According that data, only 0.9 percent of children experienced confirmed maltreatment in 2011. The second examines maltreatment based on self-reported data, which in some cases has found that more than 40 percent of children can expect to experience maltreatment. Wildeman and colleagues — Natalia Emanuel, John Leventhal, Emily Putnam-Hornstein, Jane Waldfogel and Hedwig Lee — put themselves in the middle of those two methods to calculate the cumulative risk of maltreatment using confirmed case data.
“Even though few children experience maltreatment in any given year that doesn’t mean that few children will ever experience it,” Wildeman said. “Our broader motivation for doing this study is that things that happen to small proportions of kids are easier to ignore. They’re horrible and tragic and they pull at the heartstrings, but they don’t seem to matter much at a broader level. (With our findings), it becomes harder to say that.”
In addition to the one-in-eight finding, the study uncovered some startling disparities as well. For black children, the cumulative prevalence of maltreatment is one in five and for American Indian children, it’s one in seven. Overall, nearly 21 percent of black children are estimated to experience maltreatment, followed by 14.5 percent of American Indian children, 13 percent of Hispanic children, 10.7 percent of white children and 3.8 percent of Asian/Pacific Islander children. Girls are more likely to experience maltreatment than boys. Wildeman said he was shocked by the high prevalence among black children — “that’s the finding that kept driving us to go back to check and recheck our data and analysis.”
“The fundamental causes of disparities we see are about life circumstances that make parents feel overwhelmed,” he said. “This is fundamentally a structural issue; it’s not about individual parenting.”
Wildeman told me that if one in eight children are experiencing maltreatment so severely and consistently that it’s being confirmed by child protection officials, it suggests that many more parents than we’d like to believe are feeling completely overwhelmed and don’t have the resources to properly cope. He said he hopes advocates use the study’s findings to call for supportive policies and programs, whether it be reimbursement for nurse home-visiting programs, paid sick leave policies or something as seemingly simple as a safe neighborhood playground.
From a public health perspective, childhood maltreatment is linked to profound health effects throughout the lifespan. As Wildeman and his colleagues noted in their study, such maltreatment is associated with higher rates of mortality, obesity, HIV infection, mental health problems, suicide and a higher likelihood of engaging in criminal behavior. The cost of childhood maltreatment in the U.S. is estimated at $124 billion each year, with per-person costs akin to diseases such as diabetes or stroke.
Indeed, because such maltreatment is linked to so many health problems later in life, preventing adverse childhood experiences is often described as the ultimate primary prevention tactic. For example, public health officials with the Centers for Disease Control and Prevention have called on communities to rally around the primary prevention of child abuse and neglect in their “Essentials for Childhood Framework,” which argues that creating community environments that support safe, stable and nurturing relationships between children and caregivers could be key in preventing childhood maltreatment and raising healthy adults.
“We need to support proactive public policies to try to make parenting less overwhelming for people,” Wildeman said. “Diminishing childhood maltreatment rates is something we need to take very seriously.”
To request a full copy of the study, visit JAMA Pediatrics.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
I’m not sure why I’m compelled to write each time the Labor Department releases its Spring and Fall agenda on worker safety regulations. The first time I did so was December 2006 and I’ve commented on all but one of the subsequent 14 agendas. But the ritual is largely disappointing.
On its regulatory agenda, OSHA will indicate its intention to make progress on a proposed or final worker safety rules. It will provide target dates to complete key tasks for each of those rules. But for the majority of the regulatory topics, by the time the next regulatory agenda rolls around six or more months later, all we see are target dates further into the future. Here’s a typical example:
OSHA’s Spring 2011 regulatory agenda signaled it would issue a final rule in June 2012 to address the deadly hazard of confined toxic environments faced by construction workers. In the subsequent agendas, the target date was July 2013, then February 2014, and now it’s August 2014.
There’s no reason for me to believe—–given OSHA’s history of providing fictional target dates—that OSHA will issue this new safety rule by August.
It’s been the same discouraging pattern with a proposal to protect healthcare workers from infectious agents. In OSHA’s Fall 2011 regulatory agenda, the agency suggested it would convene a panel of small businesses in March 2012 to review its draft proposal on the topic. In the subsequent agendas, the target date was April 2013 and then January 2014. The regulatory agenda released last month by OSHA set the target date for May 2014. May 2014 has already come and gone.
The example that baffles me the most concerns a rule to protect workers who are exposed to beryllium. The super strong and lightweight metal is a carcinogen and can cause a disabling fibrotic lung disease. Materion, the world’s largest producer and supplier of beryllium (and the only U.S. manufacturer of it), and the United Steelworkers (USW) are the two key players with interest in an OSHA regulation on beryllium. They’ve also been around long enough to know the snail’s pace of OSHA rulemaking.
Materion and the USW took it upon themselves to make OSHA’s job easier. They gave OSHA the full text of a draft regulation. For the two years prior, Materion and USW negotiated the document, and they delivered it to OSHA in February 2012. Mike Wright, the USW’s director of health, safety and environment described the proposed regulatory text as:
“a mutual search for feasible measures that would best protect workers. We worked through many disagreements, but worker health was always the goal for both parties.”
I’m sure Materion and the USW thought their two-year effort would jumpstart OSHA into a beryllium rulemaking by doing some of the agency’s work. Their contribution was not just writing the regulatory text, but working through the contentious issues that would surely have bogged down OSHA. It was the regulatory equivalent of being handed a present on a silver platter with a big red bow.
But even in this case, the fiction of OSHA’s regulatory agenda continues. First the agency said a proposed rule would be published in July 2013, then in October 2013, then in April 2014. This latest agenda sets the milestone at July 2014. I bet the USW and Materion are saying “we’ll believe it when we see it.”
During the G.W. Bush Administration, my blog posts about OSHA’s regulatory agenda were critical and harsh. In agenda after agenda, the target dates for most regulatory action on worker safety rules moved further and further into the future. I was quick to criticize the lack of progress. I’ll be honest, I really didn’t expect anything different from that Administration.
Regrettably, little has changed. The regulatory agenda for the Obama Administration’s OSHA is the same fiction we read during the previous Administration.