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Surveillance: Focusing Our Efforts

How do we know which occupational safety and health problems to focus on? Which are the most important? What new problems arise as the industry changes, as new technology, processes or chemicals are introduced?

These important questions were the focus of a May, 2013, meeting of the Council of State and Territorial Epidemiologists (CSTE) in Washington, DC, at the Bureau of Labor Statistics (BLS).

First, the epidemiologists looked at the main source of information about injuries and illnesses in the workplace, the BLS Survey of Occupational Injuries and Illnesses (SOII). Recently, a number of studies have shown that the SOII is not accurate. Injuries are undercounted (not reported), and illness underreporting is even more dramatic. A new study from Michigan shows that even amputations are dramatically underreported on OSHA logs. About half of the missing amputations were reported, but misclassified as other injuries.

Employers have a number of incentives to underreport or misclassify injuries, such as lower workers’ compensation premiums and better prospects for winning bids. In light of this, how can we really know what is happening in the workplace and use that information to help prevent injuries?

Getting information directly from workers would give us better insights into the true numbers. Some countries actually conduct labor force surveys that ask about health and safety, but there is no survey like this in the U.S. However, a number of national health surveys – such as the National Health Interview Survey and the Behavioral Risk Factor Survey, which include many workers – ask questions about individual health. Hospital emergency room data is another useful source of information. Some state health departments collect data on the various work-related injuries and illnesses reported in their state and use the data to target interventions.

A major step forward would be the inclusion of industry and occupation questions on more surveys and on the electronic health records that are coming under the Affordable Care Act. As other health data are collected and surveys are done, collecting industry and occupation information will allow us to more easily see, for example, how many laborers experience hearing loss or other illnesses.

Another answer is to not use just one source of data. A truer picture can be gained from looking at several sources (such as hospital data and surveys of workers).

OSHA has been cracking down on employer underreporting and on incentive programs that discourage reporting (like safety bingo or awards for numbers of hours without a lost workday injury). But OSHA only inspects a small percentage of workplaces each year. The agency is now looking at electronic recordkeeping for OSHA logs which may ultimately make it easier to collect information and get a more accurate picture of the national data than the current BLS sample provides. OSHA is also considering requiring employers to immediately report all work-related amputations and all injuries resulting in hospitalization. Currently, immediate reporting is required only for fatalities or catastrophes involving hospitalization of three or more workers.

While all employers like to see low injury rates at their workplaces, some need to be convinced that having a truly low injury rate is better than one that just looks good on paper. It may be harder to achieve, but in the long run, it is better for both their employees and their bottom lines. Encouraging reporting of injuries may seem counterproductive, but only by knowing the true picture of injuries can an employer begin to figure out how to prevent them. The next step is even harder. As injuries decline and there are fewer to count, there are also fewer from which to learn. Then, it is necessary to urge the reporting of close calls or near misses. These are almost-accidents or accidents waiting to happen. Looking at the nature and causes of close calls will provide even more of a boost toward injury prevention.

Employers and OSHA pay attention to the numbers. What gets counted counts. This is why it is so important to get the numbers right. Otherwise, we could be wasting effort on minor problems and not paying attention to big ones. Quantifying this problem accurately may also help garner more public support for occupational safety and health and for OSHA; support that is desperately needed in these tough economic times.

Are Injury Rates Really Dropping?

The rate of injuries in construction (the number of injuries per 10,000 full time workers) has been dropping for years.

That would be good news, if it were true. New research questions how real that decline is. Researchers studied the injury rates in construction by state from 2003 to 2008. They also looked at the rate of fatal construction injuries in those states during that period. They found that states with lower rates of fatal injuries had higher rates of non-fatal injuries and vice versa.

It is hard to hide workplace deaths so the researchers assume that the fatality rates are fairly accurate. They conclude that the recent drop in injury rates is “either an incredible accomplishment or a gigantic misperception – or some of both.”

This research underscores the need identified by the CSTE workshop to figure out the true rate of injuries and illnesses in the workplace.

American Journal of Industrial Medicine, Volume 56, Issue 5, pg 509–519, May 2013

[Scott Schneider is the LHSFNA’s Occupational Safety and Health Division Director.]

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