It was one of those weeks when two seemingly unrelated topics crossed my desk. Only later did it strike me that they were connected. Both involved toxic substances and what we know about their adverse health effects. One concerned the contaminated water supply in West Virginia. The other involved a commentary by attorney Steve Wodka about a newish revision to OSHA’s chemical right-to-know regulation.
The drinking water emergency in West Virginia—thousands of gallons of MCHM (methylcyclohexanemethanol) which flowed into the water supply— has focused attention on the inadequacy of the key law for US chemicals policy, the Toxic Substances Control Act (TSCA). Many residents want to know, and journalists have been asking: “how is MCHM going to affect people’s health?”
Quickly they learned the manufacturer of MCHM doesn’t have a clue about its long-term health effects. Nothing about how it might affect their kids. Nothing about effects on the offspring of those who drank it. Nothing about whether it may cause neurological problems, or cancer. There’s no law–not TSCA or any other—that even expects them to know, and there’s no law requiring them to find out. For now, we are resigned to live in a giant black hole, with far too little health information about the 80,000 chemicals that are manufactured or processed in the U.S.
As Richard Denison with the Environmental Defense Fund wrote:
“How, you might well ask, is this possible? How can a chemical in active production and use – and now being released into the environment and exposing people – be on the market without any publicly available hazard data or evidence of its safety?”
There are however, a few chemicals about which there is ample information on some of their long-term health effects, specifically whether the cause cancer. (Largely because people served as guinea pigs in their workplaces, were exposed to toxic agents, and developed cancer as a result.) Both the International Agency for Research on Cancer (IARC) and the US National Toxicology Program (NTP) have sophisticated review procedures, involving panels of scientific expert, to evaluate the epidemiological data and identify compounds for their carcinogenicity. To-date, the groups have independently classified about 60 substances as known human carcinogens. They’ve also designated some substances as likely to be or possible human carcinogens; IARC lists about 400 and NTP about 200 of these suspect compounds. At least for these toxic substances, individuals who are exposed or potentially exposed are not quite as stuck in that information void.
For nearly 30 years, workers who used or came into contact with these designated or suspect carcinogens had the benefit of a cancer warning label on containers of these compounds. If IARC or NTP classified them as carcinogens, OSHA required labels on containers of them to include the cancer warning. I say had because of what I read in Steve Wodka’s commentary.
In “Explaining the Inexplicable: OSHA’s Gift to the Chemical Industry,” Wodka writes:
“Until 2012, OSHA had a rule which required that a cancer warning label be placed on a chemical if it appeared on a national or international list of cancer causing chemicals. The rule was clear, simple and easy to enforce. It was not even controversial. But it is no longer in effect.”
Wodka is referring to OSHA’s 1983 Hazard Communication standard, which was amended in March 2012 to align with the “Globally Harmonized System of Classification and Labeling of Chemicals.” He points to a change between the old and the new HazCom standard that I’m embarrass to admit never made it on my radar screen. He explains:
“OSHA decided to toss this entire system overboard and return to the olden days when these disputes were settled not by the quality of the evidence, but by the number of gunslingers one could hire. Under OSHA’s new “globally harmonized system” of hazard communication, a chemical manufacturer can dispute the science on which a cancer designation had been based. When these disputes arise, OSHA, not the manufacturer, bears the burden of proof. The agency will always be outgunned by the global chemical industry and worker protection will suffer. Inexplicably, this wound was completely self-inflicted. No one demanded or petitioned OSHA to make this change.”
The whole idea for the original 1983 HazCom standard was giving workers the “right-to-know” about the chemical hazards in their workplaces, especially how the compound could affect their health. The rule’s requirements for labeling of containers—including language about any IARC or NTP cancer designation—gave workers easy access to critical hazard information. That requirement was deleted by OSHA in 2012 when it revised its HazCom regulation. I’m glad (I guess) for Steve Wodka’s commentary bringing it to my attention.
Anxiety and frustration linger among WV residents on how little is known about the chemical that contaminated their drinking water. TSCA does nothing to help them know. OSHA’s HazCom standard used to require chemical manufacturers to label carcinogenic compounds based on IARC’s and NTP’s evaluations. Now those cancer warnings are no longer required by OSHA to be on the labels.
As the public dialogue revolves around the need for more testing and more disclosure of the potential health effects of toxic chemicals, I’ll use Wodka’s term “inexplicable” to describe OSHA’s backsliding.
“There’s a lot we don’t know about preterm birth and we know even less about the disparities in those births.”
Those are words from Ondine von Ehrenstein, an assistant professor in the Department of Community Health Sciences at the UCLA Fielding School of Public Health, who recently examined the links between occupational exposures and preterm birth rates among Hispanic women. Perhaps not surprisingly to those in the public health world, von Ehrenstein and her research colleagues did find that Hispanic women are at particular risk for preterm birth associated with certain occupational conditions. However, what may be more surprising — and what could be critical to an effective intervention — was that the effect of occupational exposure on preterm birth risk varied by nativity, or whether a woman was U.S.-born or foreign-born.
“We found higher risks related to physically demanding and shift work, especially among U.S.-born Latina women,” von Ehrenstein told me. “Why is there such a difference? We’ll need further research to really understand.”
However, Ehrenstein and fellow researchers have begun to lay the groundwork. To conduct the study, which was published in the February issue of the American Journal of Public Health, researchers examined a case-control study nested within a cohort of more than 58,300 births in Los Angeles County in 2003 and used the U.S. Census Occupation Codes and Classification System to characterize the mothers’ occupations during pregnancy. The study noted that while previous U.S.-based studies have been conducted on preterm birth and occupational exposures (which is defined as both working conditions, such as daily working hours, and environmental exposures, such as indoor air quality), they have not teased out the relationship of the mother’s place of birth.
Authors also note that rates of preterm birth are higher in the U.S. than in many peer nations. (A recent March of Dimes report found that the U.S. preterm birth rate dropped to 11.5 percent in 2012 — a 15-year low — but it’s still the highest rate among industrialized nations.) Study authors von Ehrenstein, Michelle Wilhelm, Anthony Wang and Beate Ritz write:
The prevalence of preterm birth in the United States increased over the past decades with persistent racial/ethnic disparities, and it remains the main cause of infant mortality. Hispanic women have on average a higher prevalence of preterm birth than non-Hispanic White women, and risks tend to vary by nativity (US-born vs. foreign-born). These disparities remain poorly understood and have not to date been explained by social or demographic factors. …Occupational exposure may increase risks for preterm birth by interrupting the prenatal neuroendocrine balance, thereby promoting premature parturition (birth), and these adverse occupational influences may possibly affect Hispanic populations in the United States disproportionally and may possibly also be modified by nativity.
The study found that among all women who worked during pregnancy, there was a suggestion of increased risk of preterm birth among health care practitioners and technical occupations, building and grounds cleaning and maintenance, and food preparation and serving jobs. Risks were also associated with physically demanding work as well as shift work. When zeroing in on Hispanic women who worked while pregnant, the risk was higher among health care practitioners and technical occupations.
The risk of preterm birth also increased among Hispanic women doing shift work and physically demanding jobs — however, that risk only increased among Hispanic women who were born in the U.S. and not among foreign-born Hispanic women. The elevated odds ratio for preterm birth was statistically significant for foreign-born Hispanic women working in building and grounds cleaning and maintenance (though von Ehrenstein said it’s important to note that this group of Hispanic women also represented the vast majority of such workers). Still, foreign-born Hispanic women working in such maintenance jobs faced a preterm birth risk two-and-a-half times larger than women working in the office and administrative support sector.
“These ethnic disparities indicate that there is room for prevention,” von Ehrenstein said.
Researchers hypothesized a number of reasons for the differences. For example, the pronounced risk among Hispanic health care workers might indicate that such workers are “doing especially heavy physical work, although we currently have no evidence for this,” the study stated. Authors also noted that “lower acculturation has been reported for foreign-born compared with US-born Hispanics, and it has been associated with better support networks, healthier nutrition, and lower rates of smoking and alcohol consumption, reflecting healthier practices among women in the country of origin.” However, Ehrenstein pointed out that some of the biggest factors influencing pregnancy outcomes may be exposures that occur early in life — what she called the life course perspective — which could help explain the differences by nativity.
von Ehrenstein said the findings on nativity could be especially helpful when developing interventions. She also said that working to improve birth outcomes and infant health today — whether through policy or program — can reverberate throughout the lifespan.
“Early health risks may have lifelong implications,” von Ehrenstein said. “So if we want to reduce health costs and the implications for public health, a prime venue for prevention is really in promoting healthy pregnancies.”
To access the full 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.
In 2012, a Frontline and Pro Publica investigation of the cell (or wireless) tower industry found that between 2003 and 2010 the average fatality rate for the US tower industry was more than 10 times greater than that of the construction industry. A January 6, 2014 story by KUOW reporter John Ryan about the death in January 2013 of tower climber Mike Rongey in Mount Vernon, Washington is a reminder that the industry remains extremely dangerous. It is also a reminder that the employers of the workers killed in these incidents may only be fined minimally and that the wireless service providers generating the work are rarely – if ever – cited for these accidents. In Mike Rongey’s case, the state has levied a penalty of $450 against the company that employed him.
According to the Wireless Estimator, a website that tracks communications tower industry news, in 2013, thirteen US cell tower workers died on the job. Add to these deaths the most recent such incident reported by the US Occupational Safety and Health Administration (OSHA): On November 22, 2013, a maintenance worker died in a fall from a communication tower in North Witchita, Kansas. Cell tower worker fatalities cited by the Wireless Estimator occurred all across the country, in Indiana, Massachusetts, Maryland, Mississippi, North Carolina, North Dakota, Oregon, Virginia and Washington. Most of these cases are still under federal OSHA or state investigation so full incident detail and penalty information is not yet available. However, in November OSHA issued a memorandum for its regional administrators calling the past few months’ rate of injury and fatalities in the cell tower industry “alarming.” The number of such incidents in 2013, OSHA noted in the memo, was more than the previous two years combined.
Mike Rongey’s employer, WS Consulting & Construction, has been fined $450 for violation of telecommunications industry general safety rules, specifically for violating fall protection standards – that is, not providing proper fall protection, explained Washington Department of Labor and Industries spokesperson Elaine Fischer.The penalty amount, Fischer explained, is calculated based not only on the type of violation involved, but also on the number of employees the company has, how many employees were exposed to the hazard that caused the injury or fatality, and the employer’s history of violations. That the incident caused a worker’s death does not determine the size of the fine, she explained. In Mike Rongey’s case, his employer is a very small company, and only one employee – Rongey – was exposed to the hazard, Fischer said. What caused the fall was equipment that was improperly installed not by WS Consulting & Construction, but by another company that is, according to Fischer, no longer in business. And neither Rongey’s employer nor the company that installed the faulty equipment owns or manages that cell tower or uses it to broadcast wireless signals.
A multi-layered industry
How the layers of contractors and subcontractors affect cell tower workers’ safety is of major concern to Wally Reardon, project coordinator for the Workers at Heights Safety and Health Initiative affiliated with the Occupational Health Clinical Center in Syracuse, New York. As Reardon explains, the carrier – in the case of the tower where Mike Rongey fell – might be Clearwire, which is now part of Sprint, or a company like AT&T, T-Mobile or Verizon. The company that owns the tower might also be a cellular service provider or telecommunications company such as Cox Communications, Time Warner or US Cellular. There are also companies that specialize in operating, building and leasing towers, as do Crown Castle (which owns the Mount Vernon, WA tower where Rongey fell), American Tower and SBA Communications, among many others.
In addition to complex layers of ownership, other companies, known in the industry as “turfers,” may be involved in managing these jobs. Turfers such as Bechtel and General Dynamics might hire other companies to do work in particular “market” or city, Reardon explains. If that company has too much work to complete on schedule, it might then subcontract out some of that work to another local company. The use of temporary workers to fill positions because of demands to upgrade infrastructure also adds to these layers, he noted.
This concern was also voiced by OSHA in its November 2013 memo in which OSHA said it “is aware that there has been an acceleration in communication tower work during the past year due to cellular infrastructure upgrades, and the Agency is concerned about the possibility of future incidents.”
There are rigorous safety standards for all aspects of cell tower work, as there are for tower construction and engineering, Reardon explained. There are also safety checklists and procedures that workers are required to follow – but under the pressure to meet job deadlines, follow-through can be lacking, he said.
Exacerbating these issues in Reardon’s opinion is the lack of organized support for tower workers, most of whom are not represented by labor unions. Tower workers are often reluctant to raise safety issues with their bosses, he said, for fear of being “blacklisted” or not hired for future jobs. If companies throughout the cell tower supply-chain, particularly the large companies with large assets and brands, could be held accountable that “would improve safety 100 percent,” said Reardon.
OSHA does have the ability under certain circumstances to use its “Multi-Employer” policy in citing companies for health and safety violations. But as Deputy Assistant Labor Secretary Jordan Barab explained to Frontline in 2012, it’s generally used only when the companies have employees working on the site where the violations occurred. Asked on January 9, 2014, OSHA was not able to respond to The Pump Handle by deadline to say if it had progressed in addressing the issues related to multiple companies’ involvement in cell towers and the responsibility for the safety of work on the towers.
Washington State’s Department of Labor and Industries spokeswoman Elaine Fischer said that a hearing on Mike Rongey’s case was expected to begin the week of January 13th and that Washington State is “preparing to adopt new cell tower specific regulations” that she expects will be released in 2014. Only two states, Michigan and North Carolina, currently have cell tower specific safety regulations. Among the issues the Washington regulations are expected to address are those related to multiple company responsibility, thermal radiation and self-rescue – the last being of particular concern to cell tower workers in remote locations.
The annual number of US cell tower worker deaths appears to be declining since 2006, when 19 workers died. But that more than a dozen cell tower workers died from work-related injuries in 2013, when OSHA records 31 accidents and 267 violations in its 285 recorded inspections in the industry, suggests that safety improvement is badly needed.
Meanwhile, the company cited in Mike Rongey’s death is contesting the $450 penalty.
[UPDATE 1/17/14: On January 17, 2014 an OSHA spokesperson sent the following statement: "OSHA is aware of the very serious nature of the hazards in communications tower work and conducts inspections in this industry. Among other activities, the agency has been gathering data on the 14 fatalities that occurred in 2013, including information on the contractual relationships associated with the activities in which a worker was killed." OSHA also referred to its memo cited above and said, "Under the OSH Act, employers may be responsible for hazards to their subcontractor’s employees if they maintained sufficient control over the work or worksites of those subcontractors. OSHA is committed to increasing its outreach and enforcement efforts in order to prevent further fatalities and injuries, and will continue to work to address the safety of cell tower workers."]
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.
Worth reading: West Virginia chemical release, antibiotics in agriculture, and using statistics to tackle substance abuse
A few of the recent pieces I’ve liked:
Ken Ward Jr. in the Charleston (WV) Gazette: Why wasn’t there a plan? Key players knew of potential for Elk River spill and State ignored plan for tougher chemical oversight (also check out opinions on the West Virginia chemical release from Deborah Blum at Elemental and Tom O’Connor at National COSH)
Jia Tolentino interviews MacArthur “Genius” Grant-winning statistician Susan Murphy at The Hairpin. (“Susan Murphy is a statistician developing new methodologies to evaluate treatments for chronic and relapsing disorders like depression and substance abuse.”)
Alexander Zaitchik at Salon: Big Ag’s big lie: Factory farms, your health and the new politics of antibiotics
Maryn McKenna at Superbug: Can Antibiotics User Fees Force Down Drug Mis-Use and Overuse?
Becca Aaronson in the Texas Tribune: Providers Face Obstacles in New Women’s Health Program (via Reporting on Health)
It’s probably my earliest public health memory — the image of Surgeon General C. Everett Koop and his grandfatherly beard on the television warning my elementary school self about the dangers of smoking. He was the first doctor I knew by name.
But while Koop may be the surgeon general that people of my generation most likely associate with the public health movement to reduce smoking, he wasn’t the first to speak out against tobacco. Koop was carrying on a legacy that began decades before with the nation’s ninth surgeon general, Luther Terry, who on Jan. 11, 1964, released the first surgeon general’s report on smoking and health and said unequivocally: “Cigarette smoking is a health hazard of sufficient importance in the United States to warrant appropriate remedial action.” On the 50th anniversary of that declaration, public health advocates are celebrating hard-fought declines in the smoking rate and warning that it’s no time to retreat.
“We have made enormous progress in the past 50 years, preventing millions of deaths and tens of millions of illnesses,” said Centers for Disease Control and Prevention Director Tom Frieden. “But we have much further to go — tobacco remains, by far, the single leading preventable cause of death in the United States and the world.”
In that first surgeon general’s report, the authors wrote:
In the early part of the 16th century, soon after the introduction of tobacco into Spain and England by explorers returning from the New World, controversy developed from the differing opinions as to the effects of the human use of the leaf and the products derived from it by combustion or other means. Pipe-smoking, chewing and snuffing of tobacco were praised for pleasurable and reputed medicinal actions. At the same time, smoking was condemned as a foul-smelling, loathsome custom, harmful to the brain and lungs. The chief question was then as it is now: is the use of tobacco bad or good for health or devoid of effects on health? Parallel with the increasing production and use of tobacco, especially with the constantly increasing smoking of cigarettes, the controversy has become more and more intense. Scientific attack upon the problems has increased proportionately. The design, scope and penetration of studies have improved and the yield of significant results has been abundant.
Considering that this report is just 50 years old, it’s amazing how much public health has achieved (and keep in mind how enormously difficult it is to change people’s behavior, especially when public health has been continuously and enormously outspent by tobacco marketers). In fact in 1999, CDC ranked the declines in smoking and the lives saved as one of the greatest public health achievements of the 20th century. According to the agency, smoking rates declined from more than 42 percent in 1965 to less than 25 percent in 1997, and the percentage of adults who never smoked went up from 44 percent to 55 percent. About half the country is now protected by smoke-free workplace laws.
A more recent study published Jan. 8 in the Journal of the American Medical Association found that tobacco control efforts (education, cigarette taxes, smoke-free laws, media campaigns, sales and marketing restrictions, and cessation programs) have saved 8 million lives in the last five decades, with more than half of the lives saved younger than 65. In all, a gain of 157 million years of life is associated with tobacco control efforts. Without tobacco control, the study found that life expectancy among both men and women would be shorter by two to four years.
Still, more than 40 million adults and 3 million youth smoke in the U.S., and tobacco use results in hundreds of billions of dollars in medical costs and lost productivity. Worldwide, it’s estimated that 1.3 billion people smoke and 4.9 million people die every year from tobacco-related disease. On top of that, tobacco companies still spend billions on advertising every year — $8.37 billion on cigarette marketing in 2011 in the U.S. alone. At the same time, state spending on tobacco prevention doesn’t meet CDC recommendations. For example, officials estimated that although states collected more than $25 billion in tobacco taxes and legal settlements in 2013, lawmakers spent less than 2 percent of that on cessation and prevention. Plus, public health agencies continue to struggle with tight budgets and service cuts (see our previous coverage of how budget cuts are affecting health department tobacco efforts here).
In other words, there’s no doubt that continued tobacco use prevention is a steep climb. Luckily, public health folks aren’t used to easy victories.
“We still have an industry that continues to sell a product that we know is harmful and from which children are at enormous risk,” said Georges Benjamin, executive director of the American Public Health Association. “This anniversary marks an important public health success, yet we need to make sure the victory we celebrate today is not hollow.”
Since that first surgeon general’s report in 1964, 30 additional surgeon general reports have been released on the dangers of tobacco and secondhand smoke, and another is expected this year.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.