Friday, March 13, 2009

Workplace Illnesses

I want address the fourth anonymous commenter from yesterday, the person who asked about illness fatalities. The questions were: "Have you seen the 55,000 number, is it verifiable, and if it's true how come it's not news?"

The answer to the first part of the question is yes, I have seen the statistic of 55,000 deaths from injuries/illnesses for last year. The break out is approximately 5,000 deaths from injuries and 50,000 deaths from illnesses.

The answer to the second part of your question is that it depends on how you define verifiable. I don't mean to sound like a bureaucrat (which I am) or a lawyer (which, thankfully, I am not), but the deaths from illnesses are not physically counted, they are statistically estimates by physicians and epidemiologists (unlike injuries which are based on reports of fatalities with some extrapolation). For as long as I've been in safety and health there has always been a 1:10 relationship between fatalities from injuries and fatalities from illnesses. I've never read anything on the actual method used to derive the number, so I don't know if it's a relationship that's been around so long that it is assumed to be correct or if it has been more recently validated. If someone who reads this knows more please feel free to post the information as a comment or e-mail me and I'll make sure to bring it out. I consider it a verified and reasonable estimate because it is scientifically derived (I believe that most of the safety and health profession will agree with me on that).

As for why it isn't news, that is the 64 Dollar Question, and I think the answer is complex. I suspect it is partially that it is so difficult to prove that these illness came from the workplace. CDC estimates that 20,000 people die each year from cancer brought on by exposure to chemicals at work. But cancer typically has a very long latency period, so how do we (everyone, not just OSHA) show that a particular cancer was contracted because of the workplace? It's easier if you can identify clusters, just looks what's happening with asbestos in Libby, Montana, but without those clusters it becomes difficult.

I also think that deaths from illnesses aren't very spectacular to anyone but family and friends (I know how cold that sounds, but believe me it isn't meant it to be). We see news clips and articles all the time about trenches collapsing and the local fire department attempting to rescue the trapped worker, or chemical plants blowing up and endangering the surrounding area, or crane collapsing and blocking traffic for hours. But we rarely see articles on deaths from illnesses because those deaths are more intimate, the people die in a hospital or a hospice or at home, often slowly, where there are no cameras.

I think it's also part of human nature to want to fix the things we see and not focus as much on those we can't. I can walk into a place of business and see the guards are off the machines, that's easy for me to see and cite. It's easy for the employer to correct. But when I walk into a hospital and see a sterilization machine that is supposed to be a closed system, I may not pick up on the ethylene oxide leak and the employer may not have the maintenance program in place to catch the problem.

I also think physicians have a part in this. My doctor has never asked me for my work history. How can a disease be linked to the workplace if the treating physician doesn't know anything about the patients workplace?

There are probably other factors I have even though of (I would love to hear more ideas).

What does this mean? To me it means that we, as an agency, need to do a better job of targeting illnesses. How? Now that is a good question, and I'll throw out some ideas in a later post in the hopes of stimulation a conversation and some new ideas.

2 comments:

  1. A little insight from a state fortunate enough to get substantial funding from NIOSH to run a FACE program and from BLS to run CFOI: we essentially don't count illnesses. Acute exposures like carbon monoxide we count; toxic inhalations that lead to organ failure months later we try to count; but cancers we don’t touch for the census, not even mesothelioma or other probable asbestos. We see the lists of past employers in the comp claims from those families seeking benefits. It is depressing to imagine what exposures must have been like decades ago. We do try to confirm cardiac deaths that started at work or outright occurred at work, but they are just filed.

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