Occupational Injury, Illness, and Fatality Prevention Through Design (PtD)

  • Date: Nov 09 2010
  • Policy Number: 20106

Key Words: Occupational Health And Safety, Workplace Injury

Related Policies: APHA policy statement 61-18: Accident prevention teaching in engineering schools

Each year in businesses across the United States, 5,800 people die of injury; 26,000 to 72,000 die annually from workplace illnesses.2 Nearly 4 million suffer serious injuries, and 228,000 become ill from work-related exposures.3 The annual direct and indirect costs of occupational injury, disease, and death range from $128 billion to $155 billion.4 Although the underlying causes vary, recent studies5–7 implicate design in a large proportion of all workplace injuries. An Australian study5 implicated design in at least 37% of all job-related fatalities during a 2-year period. The results from this study indicated that design is a contributing factor in occupational fatalities. The study identified design-related factors, including lack of rollover protective structures or seatbelts in motorized vehicles, such as tractors; inadequate machine guarding; lack of residual current devices leading to electrocution; and failed hydraulic lifting systems. 

A 2006 Center for Construction Research (CPWR)8 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. The author found that in one third of the cases, the hazard that contributed to the incident could have been eliminated or reduced if prevention through design (PtD) measures had been implemented.

To understand how the design is linked to safety in construction Behm et al.,9 reviewed National Institute for Occupational Safety and Health (NIOSH) Fatality Assessment Control and Evaluation reports and found that a lack of safety considerations at the design stage were linked to the fatality. Some measures identified were—

  • Designing built-in anchorage systems for fall protection and scaffolding (54 deaths)
  • Locating the existence of overhead power lines on the contract drawings (10 deaths)

In Europe, a 1991 study10 concluded that 60% of fatal accidents resulted from decisions made before construction projects began. In addition, case studies identifying design-related failures as responsible for occupational mortality and morbidity have been published in occupational safety and health literature, ranging from inadequate rollover protective structures on farm tractors11 to the need to redesign the computer mouse.12 These and other studies demonstrated that design is one of the original influences in determining eventual workplace safety; it influences numerous factors and circumstances that immediately affect workplace safety such as planning, procedures, behavior, worker action and inaction, and others. Further, at the design phase, it is possible to remove occupational hazards without any risk to workers.13 Thus, to protect the 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. PtD is an occupational health and safety strategy that identifies, eliminates, or mitigates workplace hazards during a project’s development, design, and engineering. The purpose of PtD is to provide a systematic approach of including hazard prevention strategies at the design and development stages of projects that affects people in the occupational environment to stop or reduce occupational-related injuries, illnesses, fatalities, and hazardous exposures. 

PtD is accomplished through the application of hazard elimination and risk minimization methods in the design of work facilities, processes, equipment, tools, and work methods. Although the ultimate goal is to “design out” potential hazards at the beginning phases of a project, rather than dealing with problems inherent in completed systems, PtD methods can effectively be applied to existing processes and equipment. Eliminating hazards and minimizing risks during the design, redesign, and retrofit of facilities, work processes, and equipment may ultimately save money and, more critically, protect workers.

In construction,14 where these principles are beginning to have traction, there are many examples of designing construction worker safety into the project that are relatively easy to implement and are effective in reducing hazards to construction workers.

  • Specifying or designing steel columns with holes in the web at 0.53 m and 1.07 m above the floor level to provide support locations for guardrails and lifelines: By eliminating the need to connect special guardrail or lifeline connections, such prefabrication details facilitate worker safety immediately on erection of columns. Falls are the leading cause of death in construction, with more than 400 occurring each year. Built-in fall protection anchorage systems can continue to be used after the construction phase for building maintenance operations.
  • Designing components to facilitate prefabrication in the shop or at ground level so that they may be erected as complete assemblies: The purpose is to work at ground level whenever possible to reduce worker exposure to falls, being struck by falling objects, and other hazards.
  • Designing underground utilities to be placed using trenchless technologies: The purpose is to eliminate safety hazards associated with trench cave-ins and falls, especially around roads and pedestrian traffic surfaces.
  • Designing roadway edges with shoulders to support the weight of construction equipment: The purpose is to prevent heavy construction equipment from crushing the edge of the roadway and overturning.
  • Designing adequate clearance between the structure and overhead power lines: Identifying the need to bury, disconnect, or reroute existing power lines around the project before construction begins removes the hazards of overhead power lines being struck during when cranes and other tall equipment are in operation. Electrical hazards are the third leading cause of fatalities in construction.

For many work environments—from construction projects to laboratories, to manufacturing plants—PtD can establish a framework for including worker health and safety into the project or product delivery process. Worker health and safety hazards should be identified, then risk minimization goals can be established during project conceptualization. This allows, from the very beginning of the project or product development, owners, architects, engineers, constructors, and developers to all recognize occupational health and safety as a project goal. It also requires them to work collaboratively to achieve worker health and safety along with other project goals established during conceptualization. 

A similar PtD framework can be applied to new product development, including the processes, equipment, and tools used to produce new products. Identifying occupational health and safety hazards during new product discovery and development and, where possible, eliminating the hazards or substituting less hazardous agents is the ultimate goal of PtD. This can be more effectively done when occupational health and safety professionals collaborate with designers engineers and manufactures during new product discovery.

When hazards cannot be eliminated or substituted, PtD seeks to minimize risks to workers through the application of engineering controls. Including engineering controls during product, process, and equipment development has been identified as the most effective, and, ultimately, least expensive method for minimizing risks to workers and likely other users of a building or facility. For example, research has shown that safe resident lifting programs that use patient lifting devices reduce resident-handling workers’ compensation injury rates by 61%, lost workday injury rates by 66%, restricted workdays by 38%, and the number of workers suffering from repeat injuries.15 Similar findings have been reported by other investigators.16 Even for hazards associated with traditional building trades, such as silica, research indicates that engineering controls are cost-effective interventions to save lives from silicosis.17 

Although there is a long history of designing for public safety and environmental sustainability in the United States, less attention has gone toward factoring the safety, health, and well-being of workers into the design, redesign, and retrofitting of new and existing workplaces, tools and equipment, and work processes. Several reasons have been suggested, including increased capital costs to “design in” worker health and safety as well as concerns for increased liability.18 This has been primarily because of concerns about the higher upfront, out-of-pocket costs associated with instituting safer designs over the poorly understood costs savings that occur over the life cycle of the process, product, or facility. In addition, designers have been advised to avoid addressing worker safety to avoid the assumption of liability from the safer designs. However, as recognition of the fact that, “predictable and unmitigated hazards are design flaws” increases, so too will interest in designing them out. Design professionals’ capacity to use this plausible deniability will disappear. The most accepted rationale as to why less attention has gone to worker health and safety in the design phase is that designers are not likely to have enough occupational safety and health training or be aware of the necessary resources to make confident judgments about worker safety.19

Two factors that are crucial to implementing designing for safety in practice are the designer’s knowledge and acceptance of the concept. Safety will not be considered in the design if the designer is not aware of the concept or how to implement it or does not accept it as part of design practice. In a study on the viability of designing for safety, designers were questioned to determine barriers to implementation. Among the perceived impact to implementation, project cost and schedule were mentioned most often along with limitations on creativity. Through interviews of engineers and architects, it was found that a large percentage of design professionals are interested in and willing to implement the concept in practice. The paper states that key changes are needed for full acceptance by design professionals:

  • Changing the designer mindset toward safety away from the “not my department attitude” 
  • Increasing the designer’s knowledge of the concept 
  • Establishing a motivational force to promote (or regulate) designing for safety 
  • Making design guidelines available for safety tools and reference 
  • Mitigating designer liability20

To address these concerns, PtD must maintain its cross-discipline approach that includes architects; industrial designers; engineers; purchasing, finance, and human resource professionals; environmental and occupational health and safety experts; and health and safety experts. To that end, the PtD National Initiative, led by NIOSH and PtD sponsor organizations including Association of Equipment Manufacturers, American Industrial Hygiene Association, American Society of Safety Engineers, CPWR, Laborer’s Health and Safety Fund of North America, National Safety Council, Mercer, the Occupational Safety and Health Administration (OSHA), Kaiser Permanente, and the Regenstrief Center for Health Care Engineering, seek to promote the inclusion of worker health and safety requirements in the design and redesign process. OSHA has also created a Design for Safety workgroup that is primarily looking at the construction industry. These are admirable starts, but support for more case studies is needed that examines the costs and benefits of this approach and that effectively addresses barriers to implementation. In addition, design solutions and guidelines for many industry sectors still need to developed and analyzed.

APHA has had a long-standing policy of teaching accident prevention in engineering schools.1 A PtD policy would broaden the concept to supplying occupational safety and health principles to disciplines that could positively affect public health by designing out hazards. APHA must help lead the nation in focusing its collective attention on eliminating hazards and minimizing risks to workers and the work environment because no single organization or occupational discipline can achieve these goals alone. Success of PtD will come through a coordinated, phased approach to activities that considers the unique challenges faced by businesses within all industrial sectors. Through the collaborative efforts of design professionals and occupational health and safety, experts working in tandem with industry, labor, professional organizations, academia, government agencies, PtD can save lives and show financial value.


APHA urges the following:

  1. All federal, state, and municipal projects should include prescriptive occupational safety and health specifications that outline means and methods of achievement or performance specifications that describe minimum acceptable occupational safety and health outcomes.
    • Provide federal, state and municipal projects with specific contract language templates that can be used during the project contracting process to enable this recommendation;
    • Research the various possible barriers to implementation of specific contract requirements;
    • Identify how to provide technically knowledgeable staff for the oversight and verification of contract compliance with the PtD provisions of the contract.
  2. Increased funding should be allocated to identify communication gaps between owners, designers, and occupational safety and health professionals to address worker well-being in the design, redesign, and retrofitting of new and existing workplaces, tools and equipment, and work processes.
  3. OSHA should include PtD in the Voluntary Protection Program and the Injury and Illness Prevention Program Standard.
  4. Case studies where the implementation of PtD has made a positive effect on worker safety and health, project quality, project cost, and other factors should be developed and implemented.
  5. The environmental sustainability movement and Leadership in Energy and Environmental Design Green Building certification process should include human resources and workers as a sustainable design criterion.
  6. Design, architectural, and engineering schools should include PtD principles in curriculum.
  7. Design, architectural, and engineering associations should support PtD professional development courses.
  8. Cross-discipline association should occur between architects, industrial designers, engineers, purchasing, finance, and human resource professionals, and environmental and occupational, health and safety experts.
  9. The NIOSH PtD Initiative should be supported.


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