Surveillance of Work-related
Fatalities in the United States:
Data for Action
Sherry Baron, MD, MPH
Professor, Occupational and Environmental Health
City University of New York
[email protected]
August 2014
Sao Paulo, Brazil
Why is this Important
4628 workers were killed on the
job in the United States in 2012
12 workers per day
Nearly 4 million non fatal injuries
Costly to Worker and Society
Total cost of fatal and non fatal injuries:
$192 billion per year
Just one of the many stories…..
Eugenio Sigaud
Acidente de Trabalho
1944
Candido Portinari – Café 1935
Candido Portinari
Candido Portinari
Died 1962
Poisoning from paints
with high levels of lead
Worker Dies at Stadium Hosting World
Cup Opener
Fabio Hamilton da
Cruz, fell about 26
feet while helping
to install temporary
seats at the
Itaquerao stadium.
Outline
How do we approach occupational health
surveillance in the US
– Focus on federal and state government
systems
How the data can be used to improve the
work environment
Public Health Surveillance
On-going, systematic
collection, analysis, and
interpretation of health data
dissemination of data for the
purposes of prevention
Teutsch and Churchill: Principles and Practice of Public Health Surveillance
Purpose of Surveillance
 Target prevention priorities
 Evaluate intervention efforts
 Generate hypotheses for further research
 Demonstrate need for prevention (influence
policy makers)
WHAT GETS COUNTED GETS DONE
Types of Occupational Health Data
Health endpoints:
– traumatic injuries (fatal or non fatal)
– illnesses (e.g. silicosis, lead poisoning)
– biologic measures of exposure (e.g. blood lead
levels)
Hazards
– dust or metals in the workplace
Interventions (e.g. training programs)
Types of Surveillance Systems
Population-based
surveillance
– large representative data
Case-based surveillance
– collect information about
individual cases
“Statistics are People with the Tears Washed Off”
Occupational Health Surveillance by the
Federal Government in United States
Collected, but not routinely until 1970
In 1970, the Occupational Safety and
Health Act created a comprehensive law.
Department of Labor
Department of Health &
Human Services
Occupational Safety and Health
Administration (OSHA)
Bureau of Labor Statistics
National Institute for
Occupational Safety and
Health (NIOSH)
26 State-Based Programs with
support from NIOSH grants
Major Surveillance Systems
Federal Programs created by OSHA
– Survey of Occupational Injuries and
Illnesses
– Census of Fatal Occupational Injuries
State-based systems to fill the gaps
– Case follow-up
– Hospital discharge data
– Workers compensation
Key Components in Developing
a Surveillance System
Define a “case”
Define a systematic method for
identifying cases
Define the data collected on each
case
Define the denominator for calculating
rates
Survey of Occupational Injuries and
Illnesses
Recordable cases:
– Death
– Medical treatment beyond first aid
– Days away from work, job transfer, restricted
work
– Injuries in transit to work are NOT included
Illnesses due to work involving
– Skin, Respiratory, Poisoning, Hearing loss
– Other- eg heat, cold, blood-borne, radiation
Data Elements
Demographics
– Age, Sex, Race, Birth country (for deaths),
Location
– Place, time, industry, occupation
What happened?
– Exposure
– Source
– Part of the body
Annual Survey of Occupational
Injuries and Illnesses
Required for all private sector employers
excluding agricultural employers with <11
workers
Who, What, Where
Severity and Type of “Injury”
Additional Questions for each
Incident
What was the employee doing?
– Climbing a ladder carrying tools
What happened?
– The ladder slipped on the wet floor
What was the injury or illness?
– Sprained ankle
What object directly harmed the employee?
– Concrete floor
How is this coded
A factory worker
amputates his finger
when his clothing is
caught in a
stamping machine
How is this coded
Nature
A factory worker
amputates his finger
when his clothing is
caught in a
stamping machine
How is this coded
Nature
A factory worker
amputates his finger
when his clothing is
caught in a
stamping machine
Part of
body
How is this coded
Nature
Event or
exposure
A factory worker
amputates his finger
when his clothing is
caught in a
stamping machine
Part of
body
How is this coded
Nature
Event or
exposure
A factory worker
amputates his finger
when his clothing is
caught in a
stamping machine
Part of
body
Direct
source
How is this coded
Nature
Event or
exposure
A factory worker
amputates his finger
when his clothing is
caught in a
stamping machine
Part of
body
Secondary
source
Direct
source
Developing National Rates
Statistical sample of employers used to
generate national statistics
Denominator based on full-time equivalent
workers– 1 full-time equivalent worker equals 2000
work hours per year
US Nonfatal Injury Rates
Per 100 equivalent workers
Non Fatal Work Injury and
Illness Rates 2012
Private industry average 3.4/100 workers
BLS SOII data 2012
At least 30% of Injuries are Not
Counted
Job insecurity and fear
Employers don’t record all
cases
Precarious work- contractors
Illnesses not recognized as
work-related
Translating Data to Action
Establishing Priorities for
Prevention
Most Seriousness
Highest Rates
Highest Numbers
Possibility of change
Vulnerable populations
Politics, funding
How a Case Can Lead to Action
Types of Surveillance Systems
Population-based
surveillance
– large representative data
Case-based surveillance
– collect information about
individual cases
“Statistics are People with the Tears Washed Off”
Massachusetts Surveillance System for
Work-Related Injuries to Youth <18
Workers’
Compensation
Emergency
Departments
Deaths etc.
Massachusetts Department of Public Health
Teen Interview
Teen Follow-up
Employer Follow-up
Data Analysis and Dissemination
Broad Based Prevention
Pu
bli
ho
s
cA
dm
ini
n
on
str
ati
o
rea
ti
n
me
s
tor
e
str
uc
tio
Re
c
Co
n
ing
ts
res
ran
Sto
es
ery
tau
an
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Nu
rs
Me
rch
Gr
oc
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s
Number of injuries
300
3
200
2
100
1
0
0
Injuries per 100 workers
Number and rate of work-related injuries to
teens ages 15-17 Massachusetts, 2003-2007
Occupational Injuries to Young Workers
Employed in Restaurants by Injury Type:
Massachusetts Workers’ Compensation Data 1993 – 2003
100
Percent
80
Other Restaurants (n=920)
Snack Bar A (n=184)
60
40
20
0
Sprains,
Cuts,
strains, tears lacerations,
punctures
Bruises,
crushings,
contusions
Injury Type
Source: Massachusetts Department of Public Health
Fractures
Heat burns
Translating Data to Action
Engineering
Policy and Enforcement
Educational
Massachusetts Child Labor Laws
Strengthened - 2007
New civil
enforcement
proceedings
Supervision after 8
pm
Revised work
permit process
Workplace health and safety training
State $$$$ for community
based project for youth
Teen health and safety
peer leadership program
New training
requirements in summer
jobs programs
Fatal Occupational Injuries
Census of Fatal Occupational
Injuries (CFOI)
Case Definition
Fatal TRAUMATIC injuries
Damage to the body
resulting from acute
exposure to energy:
– Heat
– Electricity
– Impact from fall
– Absence of heat or
oxygen
Within a single workday
or shift
Excludes heart attacks
and strokes
Data Sources Used to Track Fatal
Occupational Injuries
Death certificates
Workers’ comp records
OSHA records
Newspaper clipping service
Medical examiner reports
Police records
Other….more than 20 total
Usually requires 2 independent sources
Roadway Injuries
Um trabalhador municipal de 49 anos morreu enquanto
coletava o lixo residencial. A vítima e um colega de
trabalho viajavam no degrau traseiro do caminhão
enquanto seguiam para o local da próxima coleta.
A vítima caiu da traseira do caminhão quando este
passou sobre um buraco na rua, viajando a
aproximadamente 50 kilometres por hora (kmph). A
vítima caiu na rua e bateu com a cabeça no asfalto. Ele
foi levado a um hospital local onde faleceu dois dias
mais tarde.
Fall injury
Um operário de construção de 38 anos de
idade empregado por uma construtora
caiu de uma altura aproximada de 12
metros do telhado de um prédio
residencial de quatro andares ao
escorregar quando jogava uma porta do
telhado na lixeira abaixo.
Struck-By Injury
Um cortador de pedras de 38 anos de idade
empregado por um fabricante de produtos
de granito estava tentando remover uma
laje de granito de uma prateleira quando
cinco lajes de granito pesando
aproximadamente 2 toneladas caíram
esmagando o trabalhador contra uma mesa
de cimento.
Homicide
Um limpador de 35 anos de idade
empregado por um restaurante chegou ao
trabalho durante um assalto e foi
esfaqueado fatalmente no peito pelo
assaltante.
Injuries from Harmful Substances or
Environments
Dois instaladores de azulejos, um homem
de 48 anos e uma mulher de 52 anos,
morreram intoxicados por monóxido de
carbono quando trabalhavam com a
colocação de azulejos em uma residência
em construção, pois havia um gerador a
gasolina em funcionamento na garagem e
um aquecedor a gás propano em
funcionamento dentro da casa.
65% of fatalities in Hispanics were immigrants while
47% of all Hispanic workers are immigrants
Comparing US and EU Fatal Injuries
Types of Surveillance Systems
Population-based
surveillance
– large representative data
Case-based surveillance
– collect information about
individual cases
“Statistics are People with the Tears Washed Off”
Fatal Assessment and Control
Evalaution (FACE)
Led by the National
Institute for
Occupational Safety
and Health
Case based
surveillance of fatal
injuries
Puts a face on a
death and provides
prevention
recommendation
Follow up on priority causes of
deaths
. Current priorities are:
– Construction falls
– Machinery-related
– Energy industry
– Immigrant workers
FACE Process
Conducted by NIOSH investigators and 9
states
Conduct in depth on site investigations
and interviews
Develop recommendations
Distribute recommendation to workers,
employers, and safety and health
professionals
Translating Data to Action
Translating Data to Action
Engineering
Policy and Enforcement
Educational
ANOTHER FLOOR SANDER DIES; REGULATIONS URGED
The Boston Globe (Boston, MA)
•September 4, 2004 | John Ellement and Suzanne Smalley, Globe Staff |
A Story of Impact
In Boston, more than 25 fires were caused
by wood floor installation and refinishing
In 2 years, 3 Vietnamese floor refinishers
were killed in fires because a flammable
lacquer sealer caught fire
A community task force was created
Community training conducted in
Vietnamese
The governor passed a bill banning use of
flammable lacquers
Fatal Construction Falls 2013
Plan, Provide, Train Campaign
Mobile Applications Provide
New Opportunities
Safety Information provided at the worksite
– Example ladder safety application
– Sound level meters
Application being developed to collect
hazard information in the field including
photos
Ladder Safety Mobile App
Developed by NIOSH
Mobile Application for Collecting
Hazard Information
In Conclusion
Occupational health surveillance is
challenging especially in large complex
countries like the US and Brazil
Systematic data that is well collected can
be used to raise awareness about workrelated problems
It is one important step in preventing future
injuries and illnesses
Thank-you and Questions?
I’d like to acknowledge the
help of Tish Davis of the
Massachusetts Department
of Public Health