Occupational Health and Safety
Section Newsletter
Fall 2010

James P. Keogh Memorial Scholarship Awards

The Occupational Health and Safety Section is pleased to announce the recipients of the James P. Keogh Memorial Scholarship Awards.  The scholarships assist students and union members with registration for the  APHA Annual meeting, a year's membership to APHA and an honorarium to help cover  expenses for attending the APHA Annual Meeting.  This year’s recipients are:

 

Student

Catherine Clark - MPH student - Loma Linda University

Anne Fehrenbacher - MPH/PhD student - UCLA School of Public Health

 

Union

Stephen Mitchell - United Auto Workers Local 974 - East Peoria, IL

OHS Section Honorees

The Occupational Health and Safety Section of APHA is proud to announce the honorees for 2010. The awards will be presented at our awards lunch on Nov. 9 at the Denver Convention Center.  We hope you will be able to join us.

 

The 2010 OHS Section Awards are:

 

Alice Hamilton Award: Sherry Baron, MD, MPH

 

Lorin Kerr Award: Tom O’Connor, MPH

 

Tony Mazzocchi Award: Stephen A. Mitchell, BA

 

Tony Mazzocchi Award: Wally Reardon, BA

 

International Health & Safety Award: Jeong-ok Kong, MD

Violence in the Workplace – A Job Hazard in Need of a Standard

The recent shooting of a Johns Hopkins physician by a distraught family member focused media attention in Baltimore and Maryland on the issue of safety in hospitals. While the public obsessed about metal detectors and guns, local occupational health and safety researchers took the opportunity to frame this shooting as the worker safety that it is.  Section members Jane Lipscomb, Jonathan Rosen, Matt London, and myself have a 10-year history of working together on the issue of workplace violence. Jonathan Rosen, Evie Bain, Harriet Rubenstein, Barbara Silverstein, Karen Worthington, and Jordan Barab are additional Section members who are active on the regulatory aspects of workplace violence.  Jane and I worked with our university media folks to craft an op ed to the Baltimore Sun and responded to calls from the media.  Below are excerpts from our op ed.  The complexities of this issue cannot be fully explored in the typical op ed, but the following excerpts demonstrate one approach to bringing attention to this worker safety epidemic:

 

Excerpts from the Baltimore Sun, Sept. 22, 2010

“The public was stunned to learn of the shooting of a physician by a patient's family member at Johns Hopkins Hospital last Thursday, but what many people don't know is that violence in hospitals has become an everyday occurrence. Health care workers are four times as likely as the average American worker to face assault on the job, according to a federal labor report.  For those working in psychiatric units and emergency departments, the risk is considerably higher. Fortunately, most of the assaults - unlike the Hopkins incident - do not involve handguns and near-fatal injuries, but many of them are life-altering, careering-ending injuries.”

“Most of the discussion following last week's events focused on metal detectors, but metal detectors don't prevent violence toward staff by individuals who push, scratch, choke, and punch, which is far more common”…..”Transparency on the part of management and being immediately responsive to staff concerns also contribute to building a culture of safety.  But the components of such a culture are rare, based on our research and our ordinary encounters with health care workers in our roles as researchers at the Work and Health Research Center at the University of Maryland School of Nursing. Earlier this year, for example, a nurse at a hospital elsewhere in Maryland made a point to let the center know that she had been physically assaulted by a patient but received no support from her institution. She said she took several weeks of personal leave to recover.”

“Workplace violence is an invisible but deadly epidemic for health care workers around the world. Depending on the type of patient and the type of unit, estimates of hospital staff experiencing verbal and physical violence each year range from 30 percent to 100 percent. In the case of any other epidemic (salmonella or H1N1, for example), these statistics would generate alarm. But violence toward health care workers remains largely invisible to the public, remaining the purview of a few active unions, nursing associations, and researchers….”

“Patient safety and staff safety are linked. If your nurse, physician, or patient care technician is not safe, neither are you or your loved ones. As such, the public would be wise to recognize and demand improved working conditions and safety of health care workers. Health care organizations must demonstrate that staff safety is as high a priority as patient safety and that they will work with clinicians to improve security while not compromising the quality of care for which institutions such as Johns Hopkins are world renowned.”

“The dangerous jobs of the past, such as Baltimore's famed steelmaking and shipbuilding, were made safer over time by strong workplace regulations and strict enforcement. With manufacturing in decline, the "new economy" is the service sector where different--but still dangerous--working conditions exist, whether the public realizes it or not.  In the past, the Maryland Occupational Safety and Health Administration (MOSH) made manufacturing jobs safer. It's time to regulate workplace safety in our hospitals to reduce the daily risk of violence faced by the health care workforce. Other states have done so, including California, Washington, New York and New Jersey.”

“Regulations that protect health care workers from violence on the job will not turn hospitals into fortresses. Instead, regulations require clear policies, a thorough risk assessment, adequate staffing and security resources, employee training, and ongoing recordkeeping and monitoring. Last week's tragic incident of workplace violence should prompt us to call for new and stronger MOSH regulations to keep health care workers, patients, and visitors safe in Maryland's health care facilities.”


Kathleen M. McPhaul is an assistant professor and director of the Community/Public Health Program, Work and Health Research Center, University of Maryland School of Nursing.

 

Jane Lipscomb is a professor and director or the Work and Health Research Center.

Policy Statements to be Presented at Governing Council

Several policies sponsored by the OHS will be presented at Governing Council during the Annual Meeting in November.  Below is a quick summary of these policies.  Each of the policies have been posted on the APHA website and can be accessed at: http://www.apha.org/advocacy/policy.

 

Policy Statement A-3: Submitted by OHS and Co-sponsored by the Population, Family Planning and Reproductive Health Section

Title:  Prevention and Control of Sexually Transmitted Infections and HIV among Performers in the Adult Film Industry

The adult film industry (AFI) produces between 4,000 and 11,000 films each year with an estimated gross revenue of $13 billion. At the same time, there is a lack of sufficient STD/HIV prevention efforts within this industry. Analysis of data from Los Angeles County between 2004-2008 found that 18-26% of performers were diagnosed with at least one infection of gonorrhea and/or chlamydia each year, 72% of those being among females. Nearly 25% of all STD cases among women were reinfections within one year, compared to 15% of women seen in family planning and STD clinics.

 Both Federal OSHA and in California, Cal/OSHA require employers to provide a safe and healthful workplace for employees to include the use of condoms, medical monitoring and worker health and safety training by AFI employers. Despite these requirements, there has been little compliance by the industry and a lack of employer responsibility for worker health and safety. Attempts to encourage the industry to regulate itself have for the most part failed, leading to the need for national regulation of the industry and multifaceted efforts to ensure enforcement.

APHA supports the following:

  1. Federal and state mandates to reduce the epidemic of STDs in the adult film industry, which would require (a) the mandatory use of condoms, (b) appropriate medical monitoring that respects and protects the confidentiality of the performer; and (c) performer health and safety training. 

  1. Increased resources for enforcing occupational health and safety standards in the adult film industry for local health departments, state health departments and OSHA.   

3.   Increased resources to investigate and control occupational exposures to infectious diseases in order to reduce exposure to infectious diseases within the adult film industry.

 

Policy Statement B-6: Submitted by Occupational Health and Safety Section

B6: Occupational Injury, Illness and Fatality Prevention through Design (PtD)

Each year in businesses across the United States, 5,800 people die, 3.9 million suffer serious injuries, and 228,000 become ill from work-related exposures. The annual direct and indirect costs of occupational injury, disease and death range from $128 billion to $155 billion. While the underlying causes vary, recent studies implicate design in a large proportion of all workplace injuries. A 2006 CPWR study analyzed 450 reports of construction workers’ deaths and disabling injuries to determine whether addressing safety in the project’s designs could have prevented the incidents. This and other studies demonstrate that design is one of the original influences in determining eventual workplace safety.

To protect lives and livelihoods of stakeholders across all sectors of the economy a comprehensive approach is needed for including worker health and safety considerations in the design process. Prevention through Design is an occupational health and safety strategy that identifies, and eliminates workplace hazards during a project’s design and engineering stages. The purpose of PtD is to provide a systematic approach of including hazard prevention strategies at the design and project development stages that affect individuals in the occupational environment to stop or reduce occupational-related injuries, illnesses, fatalities and hazardous exposures.

APHA urges the inclusion of the safety, health and well-being of workers into the design, re-design and retrofitting of new and existing workplaces, tools and equipment, and work processes.  APHA also encourages the environmental sustainability movement and LEED Green Building Certification process to include the safety of workers as a sustainable design criterion. In addition, APHA advocates that design, architectural, and engineering schools include PtD principles in curriculum, and cross discipline association between architects, industrial designers, engineers, purchasing, finance, and human resource professionals, with environmental, health and safety experts.

 

Policy Statement B-5: Submitted by Erin Hurley and Tegan Callahan on behalf of students in the UW School of Public Health and Endorsed by the APHA International Health Section, the APHA Occupational Health Section, and the APHA Peace Caucus. 

Title: Prioritizing Cleanup of the Hanford Nuclear Reservation to Protect the Public’s Health

The Hanford Nuclear Reservation [Hanford], where the United States manufactured the fissionable materials for the world’s first atomic bomb, is the largest, most complex contamination area in the United States, encompassing four current and past Superfund sites and spanning a history of both deliberate and accidental hazardous material releases. Hanford nuclear site remediation delays and mismanagement represent a mounting threat to public and environmental health.  

The purpose of this paper is to update policy positions for the American Public Health Association [APHA] on the issue of hazardous waste cleanup at Hanford.  In 1989, the APHA passed a resolution titled Public Health Hazards at Nuclear Weapon Facilities (policy # 8917). The current position paper augments APHA’s 20-year-old resolution and provides the scientific basis and justification for ensuring cleanup at Hanford is done in a timely manner with adequate oversight.

To ensure clean up of the nuclear waste at Hanford is adequate to safeguard the public’s health, APHA adopts the following positions:


1. Reassert that the cleanup of nuclear waste sites is a public health priority. Increase awareness among public health professionals regarding the public health threats at Hanford and all nuclear waste sites to promote stronger public health policy to support comprehensive cleanup.


2. Expand the body of independent public health research on current and future health risks from Hanford.


3. Call for reasonable and effective external oversight of Hanford cleanup effort.


4. Assert that no new waste should be brought to and stored at the Hanford site until the site is cleaned. 


5.  Support formally incorporating tribal exposure scenarios and cleanup standards in the Hanford cleanup plan to restore the Hanford region and greater Columbia River Basin to where it can safetly be used by tribes as guaranteed by the Treaty of 1855.

 

Policy Statement B-7: Submitted by Tegan Callahan and Erin Hurley on behalf of students in the UW School of Public Health and Endorsed by the APHA International Health Section, the APHA Occupational Health Section, and the APHA Peace Caucus. 

Title: Intrastate and Interstate Transportation of Spent Nuclear Fuel is a Public Health Risk

Spent Nuclear Fuel (SNF) is a ‘back-end’ by-product of commercial nuclear energy generation, defense plutonium production, and research activities that utilize nuclear reactors or fission product nuclides. Transportation of SNF between production and storage sites increases the possibility of ionizing radiation exposures, which could result in adverse health outcomes.

Between 1964 and 2004, the US transported an estimated 3,056 metric tons of commercial SNF. In the event of consolidation of SNF in a federal repository, transportation of up to 70,000 metric tons of SNF may be required in merely two decades.  This increase in volume suggests that previous experience is too minimal to serve as a basis for conjecture of future risk.

In addition new policy directions suggest an increasing reliance on nuclear energy.  In February 2010, President Obama announced conditional commitments for $8.3 billion to construct and operate two new nuclear reactors in Burke, Georgia.  The American Power Act, introduced to the US Congress in May 2010, calls for significant increases in nuclear energy development as a means to generate non-fossil energy, yet contains no provisions for addressing the resultant problem of such increases—how to transport and store the SNF.  These policy shifts are silent on health and safety issues of the intrastate and interstate transport of SNF.  

It is an opportune time for APHA to adopt a position that ensures the public’s health is considered in nuclear energy policy discussions.  The position outlined in this paper builds off the history of APHA’s involvement in the nuclear waste and energy policy to:

1.  Eliminate transport of spent nuclear fuel as much as possible through commitment to an energy system reliant on renewable, non-nuclear sources.

2.  Minimize transport of spent nuclear fuel through rejecting consolidated interim storage and endorsing onsite storage as the responsible option in the absence of a national waster repository at Yucca Mountain. 

3.  Ensure safe transport of spent nuclear fuel when necessary through use of the safest modes possible and the genuine engagement of all stakeholders.

 

ACGIH Conference Update

Report on ACGIH conference July 28-29, 2010 in Chicago

On July 28-29, the venerable American Conference of Governmental Industrial Hygienists (ACGIH) called a meeting of occupational health and safety groups in Chicago to discuss a possible alliance among them to support the work of ACGIH in setting voluntary standards (the famous TLVs) and publishing educational and scientific materials for sale to the profession and the public. Eleven major OSH organizations attended the conference, including AIHA, ASSE, ACOEM, AOEC and our OHS Section of APHA (represented by Dave Kotelchuck, past Section president).

The ACGIH was founded in 1938, and in the three decades between its founding and the passage of the OSHAct in 1970 was the only national organization promulgating health and safety guidelines that were scientifically based and protective of worker health and safety. Since the establishment of OSHA the organization has continued to publish and update its annual list of TLV’s, based primarily on the voluntary efforts of many individual health and safety professionals, among them members of our OHS Section of APHA.

In recent years the membership of ACGIH has declined (as have the memberships of many of other health and safety organizations, of course), but costs to develop and update TLVs have not. Then in the early 1990s ACGIH was slapped with three lawsuits alleging that ACGIH was in fact a governmental agency masquerading as a private, non-profit organization – and indeed OSHA had in the past adopted many ACGIH standards as OSHA standards (which labor unions, OSH groups like our Section, and even many companies objected to because this action bypassed regular OSHA procedures in adopting standards based on holding hearings on each and every standard adopted). ACGIH successfully defended itself from these lawsuits, but the financial costs were enormous – well over one million dollars in legal costs alone.

In calling the Chicago meeting, ACGIH proposed an Alliance of OSH organizations: “ACGIH is seeking to expand support for its mission by developing an alliance with the key professional organizations that play an important role in developing and using scientific guidelines. Allied professional organizations would play an important role in ensuring the organization’s mission by providing financial support, encouraging a broader range of professionals to take an active role in donating to this mission, identifying professionals with needed expertise for scientific guideline development and providing input to the organization’s short- and long-term goals and activities.”

This was a good meeting in that it encouraged ACGIH to try to keep going, but none of the 11 groups which attended (including OHS) were in a position to offer money to the group, even if they might like to, nor would any be willing to assume the legal liability that might go along with such an alliance. The ACGIH folks believe that they can write terms of affiliation that will protect other allied organizations, but they admitted that of course anyone can sue them or any allied group, but the suits would lose according to ACGIH legal advisors. However the legal costs to defend could be quite stiff, as their own experience demonstrates.

Also, the proposed alliance would present important policy questions for OHS. When we have a federal agency that can enforce standards (OSHA) -- and an especially good leader of OSHA at this time -- how helpful to workers H&S are such voluntary standards? This writer has certainly used ACGIH TLVs over the decades to press employers to lower exposure levels. But considering the money and time that goes into them (an estimated $20-40K per TLV), are the cost and value worth it today as compared to pressing OSHA to develop such standards?

Also there are many in our Section who object to the whole concept of H&S standards based primarily or solely on keeping below certain exposure limits and call for worker protection without depending on them. On the other hand, ACGIH leaders are irrevocably committed to developing such occupational exposure standards (OEGs), as a matter of deep philosophical belief.

What emerged as this meeting concluded is that, pending organizational approval, many organizations would be happy to join an informal advisory board to assist and advise ACGIH and help it increase its outreach to their members. This writer would support OHS/APHA participation in such a board. While many of us, myself included, view OEGs as of real, but limited value in protecting worker health and safety, I believe it is important to support friendly organizations deeply committed to worker health and safety without overriding cost-benefit or profit-making perspectives.

When such an advisory board is formally proposed, our Section will of course have an opportunity to discuss and decide on its participation.

 ~ Dave Kotelchuck