Abstract
In 2014, more than 4,600 workers died on the job as a result of traumatic injuries, and workers suffered from an estimated 9 million work-related injuries and illnesses. This information is collected through population-based surveillance, including that conducted by the Bureau of Labor Statistics (BLS). Fatality data compiled and released by the BLS include data on traumatic occupational injuries and illnesses (but not chronic occupational illnesses). The fatality data published by the BLS do not include case-level information for each worker fatality, information that is vital for preventing future work-related deaths and creating policy and systemic change. Several other federal agencies disclose case-level details on work-related traumatic fatalities, such as the Mine Safety and Health Administration’s preliminary accident and investigation reports and the National Institute for Occupational Safety and Health’s Fatality Assessment and Control Evaluation program; however, these efforts provide information about only a limited number of the fatal occupational injuries that occur each year, leaving many deaths as statistics with little descriptive information. Therefore, these case-based surveillance systems do not create effective coverage for public health researchers and advocates to prevent future deaths and catastrophes. Case-level information that describes work-related fatalities already exists elsewhere in the public domain but is not centralized for effective use. Workers in the United States have the right to be protected from health and safety hazards at work, a process that would be enhanced by a complete approach to making this information available and accessible to the public health community.
Relationship to Existing APHA Policy Statements
- APHA Policy Statement 20106: Occupational Injury, Illness, and Fatality Prevention Through Design (PtD)
- APHA Policy Statement 8807: Surveillance of Occupational Disease and Injury
- APHA Policy Statement 8313: The Need for Accurate Job-Related Injury and Illness Data
- APHA Policy Statement 8129: Occupational Data on Death Certificates
- APHA Policy Statement 7418: Surveillance for Occupational Disease
Problem Statement
Workplace injuries and illnesses in the United States are a significant public health problem. In 2014, more than 3 million nonfatal injuries and illnesses in the workplace were reported[1]; however, the actual number is estimated to be more than 9 million owing to widespread undercounting and underreporting.[2–4] Also in 2014, more than 4,600 workers were fatally injured at work (i.e., they died as a result of traumatic injuries and illnesses),[5] accounting for a fatality rate that has remained steady over the past several years.[6] Many more workers die of workplace-related illnesses, but these numbers are severely undercounted because of the lack of a comprehensive surveillance system for work-related illnesses. In 2003, it was estimated that 55,200 work-related deaths associated with chronic illness occur in the United States each year.[7] Such estimates are only expected to increase as a result of a slow and complicated regulatory process that has not kept pace with the expansion of chemical use in the workplace. All work-related injuries, illnesses, and deaths are preventable.
Analyzing complete and accurate data on work-related fatalities is an important and effective prevention tool. Population-based surveillance allows one to monitor trends across industries, occupations, hazards, time, and other variables using aggregate data. Case-based surveillance (i.e., using factual data on the circumstances surrounding each worker death) allows one to examine root causes, identify safety and health hazards, and develop effective workplace controls. For example, case-level information helps occupational safety and health professionals (in real time and when designing more effective prevention measures) to more effectively control work-related hazards to prevent injury, illness, and death.[8] When determining how to implement feasible and effective control solutions in the workplace, the well-recognized hierarchy of controls prioritizes substituting and eliminating hazardous exposures as the most effective prevention measure, followed by implementing engineering controls, establishing administrative controls (e.g., revising work practices and organization), and, finally, requiring workers to wear personal protective equipment.[9]
Access to timely, specific information about workplace fatalities also can provide important data for investigations, inspections, or other health and safety processes used by governmental organizations, unions, and employers to improve workplace programs, policies, and interventions. Data from both population- and case-based surveillance methods are important for prevention. However, there are large gaps in the work-related data that are collected, and existing case-level data lack timing and quality and are not made accessible to the public health community, sometimes due to confidentiality concerns (even when these data are already in the public domain); such situations lead to a lost public health opportunity with respect to education, intervention, and policy change.
Three federal agencies currently use safety and health statistics to aid in fulfilling their core missions: the National Institute for Occupational Safety and Health (NIOSH) within the Department of Health and Human Services and the Occupational Safety and Health Administration (OSHA) and the Mine Safety and Health Administration (MSHA) within the Department of Labor. The Bureau of Labor Statistics (BLS), also within the Department of Labor, collects and compiles these statistics for public use. The collection and use of these data are not coordinated among agencies, nor is the information made available to state public health officials for intervention.
In 1992, the BLS started collecting information on traumatic workplace fatalities, through the Census of Fatal Occupational Injuries (CFOI), because employer reports were shown to miss 50% of these fatalities.[10] The CFOI, a federal-state cooperative program that has been implemented in all 50 states, New York City, the District of Columbia, and the other US territories, employs multiple sources to identify, verify, and profile fatal worker injuries. Information about each workplace fatality is obtained by the BLS through cross referencing of source records such as death certificates, workers’ compensation reports, and federal and state agency administrative reports. To ensure that fatal injuries are work related, cases are substantiated with two or more independent source documents or a source document and a follow-up questionnaire.
Currently, the CFOI does not collect information on or count worker deaths related to any cause other than traumatic injury or acute illness. The CFOI data do include some deaths with an immediate cause of illness, but only if there is an injury component that triggered the condition (e.g., traumatic brain injuries and injuries that result in paralysis and later death). However, deaths attributed to chronic illnesses such as workplace-related cancer, respiratory illnesses, and other diseases are not counted, and currently there are no national efforts to collect this information. The BLS counts nonfatal worker injuries and illnesses through the Survey of Occupational Injuries and Illnesses, which relies on logs from employers; the numbers produced from this survey are known to be a severe underestimation of the problem.[2–4] The true toll is probably two to three times greater than the figure reported to the BLS.
Prior to the CFOI, counts of fatal traumatic work injuries or illnesses were not collected or reported to the public at all. Data compiled by the CFOI program are now issued annually for the preceding calendar year; for example, final fatality counts and rates for the 2014 calendar year will be released in April 2016 (preliminary counts were released in September 2015). The CFOI program is an incredibly valuable population-based surveillance system for traumatic occupational deaths. To the extent possible, the aggregate data collected in the CFOI are used by the safety and health community, including workers, health policy analysts, and researchers, to help prevent fatal work injuries by:
- Informing workers of life-threatening hazards associated with various jobs
- Promoting safer work practices through enhanced job safety training
- Assessing and improving workplace safety standards
- Identifying national and state trends in industries, occupations, and demographics
- Identifying new areas of safety and health research
Some of these applications have been recognized by the CFOI program.[5] However, the data are aggregate and do not provide the case-level information that is collected through the states.
MSHA, OSHA, and NIOSH post BLS aggregate fatality data at a case level on their respective public Web sites. For example, MSHA posts comprehensive case information for all mining-related fatalities in a short time period (i.e., days to weeks) after each fatality occurs.[11] This information includes the worker’s name, workplace and employer information, and a summary description of the incident. OSHA posts limited specific information on worker fatalities and catastrophes for the current year[12]: data include the date of the incident, employer and victim names, and a preliminary description of the incident. However, OSHA posts only a fraction of all work-related fatalities (i.e., approximately 1,600 individual fatality cases were posted for the year 2014, when an estimated 4,700 employees were killed in the workplace[5]), and much of this information is not posted in a timely manner but, rather, updated at a later point. In the case of approximately one third of all fatal occupational injuries, OSHA conducts investigations of workplace fatalities to determine whether safety standards have been violated. Fatalities that occur under certain circumstances (e.g., airplane and railway crashes) fall outside of OSHA jurisdiction, as do fatalities among workers in specific industries and workforce groups (e.g., mine workers, commercial fishing workers at sea, public-sector employees in 24 states, sole proprietors, and self-employed individuals). Also, certain types of fatalities (such as homicides, suicides, and motor vehicle–related incidents) are not routinely inspected or addressed by OSHA. In addition, OSHA no longer conducts fatality investigations when deaths occur more than 30 days after an injury event.
NIOSH’s Fatality Assessment and Control Evaluation (FACE) program conducts in-depth research-oriented investigations of select work-related injury deaths to identify factors contributing to these deaths and prepares detailed case studies. FACE usually investigates cases that are new, different, unique, or emerging. FACE uses its findings to disseminate prevention strategies to those who can intervene in the workplace.[13] Only nine states are currently active in the program (California, Michigan, Washington, Iowa, Massachusetts, New Jersey, Kentucky, New York, and Oregon),[14] and NIOSH funds some of these states’ participation. Thirteen states were formerly active, and more than half of all states have not participated. In 2012, FACE published two case fatality reports from North Carolina and 34 case analyses from participating state FACE programs; in that same year, however, 4,628 workers were traumatically killed on the job in the United States. Because the aim of the program is to conduct complete investigations, FACE can provide detailed information for only a small fraction of fatal occupational injuries, and the program is too small in itself to improve availability of and access to case-level fatality data.
In 2010, the Michigan FACE program conducted an investigation into the death of a bathtub refinisher who used a methylene chloride–based paint stripping product marketed for use in aircraft maintenance.[15] FACE identified two similar cases in Michigan and alerted NIOSH; NIOSH in turn alerted OSHA, and investigators eventually determined that there had been 10 additional deaths in nine other states since 2000. Not until 2012 did the Centers for Disease Control and Prevention publish a report on these cases over a 12-year time period,[16] and this report was followed in 2013 by a joint hazard alert issued by OSHA and NIOSH on methods to reduce hazards and protecting bathroom refinishers.[17] By then, however, at least 13 workers had died on the job from similar preventable work-related hazards, even though an OSHA standard for occupational exposure to methylene chloride had existed since 1998.[18] One of the three deaths among bathtub refinishers identified through the Michigan program was not included in OSHA’s database because the decedent was self-employed and therefore outside OSHA’s enforcement jurisdiction. This fatality eventually would be counted by the BLS as a work-related case. However, because the BLS reports only aggregated statistics, chemical-related traumatic occupational deaths are grouped and publicly reported as general chemical-related deaths rather than identified according to the specific chemical involved, in this case methylene chloride. BLS and NIOSH staff resources are limited, prohibiting these agencies from searching source data routinely. If the BLS does identify any specific cases, its data use agreements prohibit the sharing of this information. This is one of the most important limitations of the CFOI: under current restrictions, it is not possible to maximize use of the available data, especially to identify emerging hazards such as those associated with bathtub refinishing.
Without case-level data, it is impossible to identify common threads that connect injuries and illnesses by nature and event or connect all of the different types of events within a given industry. Public narratives are needed to initiate injury prevention actions and derive policy changes. A holistic and systemic approach is needed for researchers and public health communities.
Evidence-Based Strategies to Address the Problem
Access to complete information related to work-related traumatic fatalities will allow public health advocates the opportunity to better advocate for prevention strategies in national, state, and local programs. Surveillance is the cornerstone of a public health system, and it is critical for prevention efforts.[19,20] The key objective of surveillance is to provide information to guide interventions, and population- and case-based surveillance systems each play a critical role. NIOSH conducts surveillance specifically among worker populations through its Occupational Health Surveillance initiative.[21] Examples include the firefighter fatality investigation and prevention program, the adult blood lead epidemiology and surveillance program, and the coal worker health surveillance program. NIOSH’s FACE program, discussed above, also is one of these surveillance programs. These programs are tailored to specific needs, however, and not to all worker fatalities.
Improved access to government data and public data can be seen in existing governmental programs. Examples include the American Recovery and Reinvestment Act of 2009, which requires recipients to disclose usage of the act’s funds and allows the public to track the data on an interactive Web map[22]; the Environmental Protection Agency’s Toxics Release Inventory, a public database of chemical releases by facilities across the United States[23]; and other public databases.
In 2009, President Barack Obama issued a directive to all agency heads to implement the principles of transparency, participation, and collaboration as the three cornerstones for an open government.[24] Facilitating improved access to worker fatality data would support the president’s direction for a transparent, participatory, and collaborative government and support informed decision making by industry, government, nongovernmental organizations, and the public. The current gaps in agency jurisdiction and data release make this collaboration even more necessary.
Opposing Arguments
In their current form, BLS data releases are intended to provide aggregate statistics on work-related deaths. Releasing information in this manner allows users to look at population-level trends and can protect the confidentiality of victims, families, and/or sources of reporting parties. Although state CFOI programs collect fatality data for the BLS, at present they are not permitted to share case-level data with public health advocates. Intrastate data sharing and confidentiality agreements determine the data that can be released and the format for reporting, and the BLS prescribes a predetermined data release schedule that the states must follow. These data use agreements often are more restrictive than necessary, and they can be improved where state law permits.
Any publicly available information in the states can be shared with the public; such information is not routinely shared, however, and practices vary from state to state. Most of the state-level data come from state programs, including public health vital statistics, state transportation department police crash reports, county or state coroner or medical investigator reports, and other public sources such as newspaper clippings and public safety officers. These public data sources often provide the worker’s name and age, the employer’s name, the date and location of the incident, the duration and status of employment, and/or a description of the events and hazards leading to and causing death. Data available from these sources already are in the public domain but are not centralized or in a form usable for public health protection. Under current restrictions, it is not possible to maximize use of the available data, especially to identify emerging hazards such as the bathtub refinishing example offered above.
The BLS also contends that releasing case-level fatality data will hinder reporting on other voluntary labor measures, such as wages and employment. However, it is not clear whether making information that is already in the public domain systematically available actually would inhibit collection of fatality information for state partners under mandatory requirements.
Action Steps
Therefore, APHA recommends that the following steps be taken to prevent workplace fatalities and to advance the transparency of worker fatality data for all public health prevention purposes, including hazard control and targeted behavioral health training of workers and employers:
- OSHA, MSHA, and NIOSH should share case-level fatality information that currently exists in public sources available in the public domain. The release of this information should be coordinated among agencies and timely to promote public health prevention strategies.
- Through its relationship with the states, the BLS should encourage state CFOI partners that collect data to provide more case-level details related to worker fatality cases and release information that is already publicly available; in addition, state FACE and CFOI programs should be encouraged to share public data in a timely fashion. In this regard, BLS also should review data use agreements that are overly restrictive.
- The BLS, OSHA, MSHA, and NIOSH should hold public hearings on the collection, coordination, and dissemination of data related to all workplace fatalities.
- The BLS, OSHA, MSHA, and NIOSH should establish pilot projects with several states to gather and disseminate information in the public domain.
- The Department of Labor and the Department of Health and Human Services should continue to meet with state epidemiologists and occupational health program staff to resolve and document data access issues. (This recommendation also is reflected in a policy position statement of the Council for State and Territorial Epidemiologists.[25,26])
- The BLS should partner with organizations such as occupational safety and health groups and unions to evaluate trends in work-related fatalities.
- Governments and other interested groups should partner to establish a comprehensive US worker fatal injury database with case-level details that would maximize information from different sources. This database should include a robust data management system that facilitates efficient data collection and coding and an open-access, user-friendly interface. These improvements will better enable workers, public health advocates, journalists, and members of the public to search for and access comprehensive data on fallen workers, their employers, and the conditions contributing to their deaths.
- Government agencies should convene a series of meetings with public health activists and researchers to establish a system for identifying, collecting, and reporting all work-related fatalities, including those due to chronic occupational illnesses; generating case-level information associated with these fatalities; and determining how this information can be used for prevention purposes.
These action steps should not infringe on the rights of the deceased and their families.
References
1. US Department of Labor, Bureau of Labor Statistics. National survey of occupational injuries and illnesses in 2014. Available at: http://www.bls.gov/news.release/osh.nr0.htm. Accessed January 11, 2016.
2. Leigh JP, Marcin JP, Miller TR. An estimate of the U.S. government’s undercount of nonfatal occupational injuries. J Occup Environ Med. 2004;46:10–18.
3. Rosenman KD, Kalush A, Reilly M, Gardiner J, Reeves M, Luo Z. How much work-related injury and illness is missed by the current national surveillance system? J Occup Environ Med. 2006;48:357–365.
4. Boden LI, Ozonoff A. Capture-recapture estimates of nonfatal workplace injuries and illnesses. Ann Epidemiol. 2008;18:500–506.
5. U.S. Department of Labor, Bureau of Labor Statistics. National census of fatal occupational injuries in 2014. Available at: http://www.bls.gov/news.release/cfoi.nr0.htm. Accessed January 11, 2016.
6. AFL-CIO. Death on the job: the toll of neglect. Available at: http://www.aflcio.org/Issues/Job-Safety/Death-on-the-Job-Report. Accessed January 11, 2016.
7. Steenland K, Burnett C, Lalich N, Ward E, Hurrell J. Dying for work: the magnitude of US mortality from selected causes of death associated with occupation. Am J Ind Med. 2003;43:461–482.
8. US Department of Health and Human Services, National Institute for Occupational Safety and Health. Hierarchy of controls. Available at: http://www.cdc.gov/niosh/topics/hierarchy/. Accessed January 11, 2016.
9. US Department of Labor, Occupational Safety and Health Administration. Fit testing procedures. Available at: https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9780. Accessed January 11, 2016.
10. National Research Council. Counting Injuries and Illnesses in the Workplace: Proposals for a Better System. Washington, DC: National Academy Press; 1987.
11. US Department of Labor, Mine Safety and Health Administration. Preliminary accident reports, fatalgrams, and investigation reports. Available at: http://www.msha.gov/fatals/. Accessed January 11, 2016.
12. US Department of Labor, Occupational Safety and Health Administration. Worker fatalities reported to federal and state OSHA, FY2015. Available at: https://www.osha.gov/dep/fatcat/fy15_federal-state_summaries.pdf. Accessed January 11, 2016.
13. US Department of Health and Human Services, National Institute for Occupational Safety and Health. Fatality Assessment and Control Evaluation (FACE) program. Available at: http://www.cdc.gov/niosh/face/default.html. Accessed January 11, 2016.
14. US Department of Health and Human Services, National Institute for Occupational Safety and Health. Participating states in FACE program. Available at: http://www.cdc.gov/niosh/face/stateface.html. Accessed January 11, 2016.
15. US Department of Health and Human Services, National Institute for Occupational Safety and Health. Michigan case report: tub refinisher died due to methylene chloride overexposure while stripping a bathtub.
Available at: http://www.cdc.gov/niosh/face/stateface/mi/10MI013.html. Accessed January 11, 2016.
16. US Department of Health and Human Services, Centers for Disease Control and Prevention. Fatal exposure to methylene chloride among bathtub refinishers—United States, 2000–2011. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6107a2.htm. Accessed January 11, 2016.
17. US Department of Labor, Occupational Safety and Health Administration. OSHA-NIOSH hazard alert: methylene chloride hazards for bathtub refinishers. Available at: https://www.osha.gov/dts/hazardalerts/methylene_chloride_hazard_alert.pdf. Accessed January 11, 2016.
18. US Department of Labor, Occupational Safety and Health Administration. Methylene chloride: final rule. Available at: https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=FEDERAL_REGISTER&p_id=13852. Accessed January 11, 2016.
19. World Bank. World Development Report 2000–2001: Attacking Poverty. New York, NY: Oxford University Press; 2001.
20. US Department of Health and Human Services, Centers for Disease Control and Prevention. Public health surveillance in the United States: evolution and challenges. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/su6103a2.htm?s_cid=su6103a2_x. Accessed January 11, 2016.
21. U.S. Department of Health and Human Services, National Institute for Occupational Safety and Health. Occupational Health Surveillance. Available at: http://www.cdc.gov/niosh/topics/surveillance/data.html. Accessed January 11, 2016.
22. American Recovery and Reinvestment Act. Available at: http://www.recovery.gov/arra/About/Pages/The_Act.aspx. Accessed January 11, 2016.
23. Environmental Protection Agency. Toxics Release Inventory database. Available at: http://www2.epa.gov/toxics-release-inventory-tri-program.
24. Executive Office of the President, Office of Management and Budget. Memorandum for the heads of executive departments and agencies. Available at: https://www.whitehouse.gov/sites/default/files/omb/assets/memoranda_2010/m10-06.pdf. Accessed January 11, 2016.
25. Council of State and Territorial Epidemiologists. Access to Census of Fatal Occupational Injuries case-level data for public health purposes. Available at: http://c.ymcdn.com/sites/www.cste.org/resource/resmgr/2014PS/14_OH_01upd.pdf. Accessed January 11, 2016.
26. US Department of Labor, Bureau of Labor Statistics. Letter from BLS commissioner to Jeffrey P. Engel in response to CTSE letter of August 4, 2014. Unpublished communication, September 17, 2014.