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

Related Policies: APHA policy statement 61-18: Accident prevention teaching in engineering schools¹ 

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 studies^5–7 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.

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. 

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:

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.