Occupational Health Issues

OCCUPATIONAL DISEASE

The term "occupational disease" refers to those illnesses caused by exposures at the workplace. They should be separated, conceptually, from injuries that may also may occur at workplaces due to a variety of hazards.

In 2001, some 137 million Americans were working, either full-time or part-time, out of a total population of some 280 million. Women make up 46 percent of the workforce.

Occupational diseases may occur in varying time frames, from the instantaneous development of illness following exposure to toxic chemicals to decades between onset of exposure and the development of disease, as occurs with many occupationally related cancers. Many time frames in between these extremes may be seen as well. Examples of varying time frames include instantaneous reactions to exposure to chemicals such as chlorine or ammonia gas; a delay of some six to twelve hours with fumes of aerosolized zinc, as occurs when welding on galvanized steel; a delay of weeks to months with lead poisoning; a delay of decades with occupational carcinogens; and even the finding of congenital malformations in children whose parents may have been exposed to hazardous materials.

Although not all occupational exposures that cause illness lead to death, considerable numbers of deaths each year are associated with workplace exposures. While it is relatively easy to count deaths due to occupational injuries, it is much more difficult for delayed illnesses. For injuries, the most recent available data indicates that more than 6,200 fatal occupational injuries occur in the United States each year, with more than 40 percent associated with transportation, and most of these related to motor-vehicle fatalities. Homicides are the second leading cause of death in the workplace, accounting for some 14 percent of the total. The leading causes of death from injuries vary by sex, with motor vehicles accounting for the greatest number of deaths in men, and homicides in women. Workers older than sixty-five have the highest rates of occupational-injury deaths. Also, smaller workplaces (those with less than ten workers) have the highest fatality rate. Many large companies invest in occupational safety and health programs and do ongoing workplace assessments. Companies with strong programs are known to have lower injury rates.

As noted above, deaths from occupational illness for most diseases are hard to enumerate. The only diseases for which reasonably good data exists are the pneumoconioses, such as asbestosis, coal-workers pneumoconiosis, and silicosis. For many other diseases, such as those from chemical exposure, various occupational cancers, and other problems, individual fatalities are difficult to recognize and record.

In the years for which data was available in the year 2000, almost 430,000 nonfatal occupational illnesses were recorded annually in the United States, with approximately 60 percent of these occurring in the manufacturing sector. The rate was almost fifty cases per 10,000 full-time workers. However, it should be recognized that many workplace-related illnesses go unreported, in part because they are unrecognized, and in part because of record keeping that is not optimal.

Among the occupational diseases most commonly reported, those relating to repeated trauma, such as carpal tunnel syndrome, tendonitis, and noise–induced hearing loss, accounted for more than 60 percent. Carpal tunnel syndrome alone accounted for almost 30,000 cases with days away from work. For those cases of carpal tunnel syndrome with workplace absence, half needed twenty-five or more days away from work. Skin diseases represented about 13 percent (58,000 cases) of work related illnesses. Dermatitis, or inflammation of the skin, resulted in more than 6,500 cases that required time away from work.

It is well recognized that these types of injuries are underreported, but a better sense can be gotten from the seven states that have an active SENSOR (Sentinel Event Notification System for Occupational Risks) program in place for some diseases. No state looks at all diseases in this way, but those that collect data concentrate upon silicosis, occupational asthma, and adult lead poisoning.

There are insufficient numbers of occupational physicians properly trained to care for the hundreds of thousands of cases of occupational disease. Only about 10,000 of some 800,000 American doctors practice in the field of occupational medicine, and only a small percentage of these have had training leading to certification as specialists in this field. Most occupational diseases are treated by primary-care physicians, and, unfortunately, many of them have had little or no training in occupational disease.

There are two government agencies that have a special role in evaluating occupational disease. The National Institute for Occupational Safety and Health (NIOSH) of the U.S. Department of Health and Human Services has the responsibility for research and prevention activities with regards to workers' health. NIOSH advises as to allowable levels of exposure, based upon scientific review. Within the Department of Labor is the Occupational Safety and Health Administration (OSHA), which has the responsibility of actually setting and enforcing workplace regulations. One of the difficulties that OSHA faces is an insufficient number of inspectors to evaluate what actually goes on at most workplaces; given the number of inspectors in the United States at the present time, it would take more than two decades for all workplaces to be inspected even once. OSHA's resources focus on fatalities. In addition to government agencies, there are a variety of voluntary groups, such as the American Conference of Governmental Industrial Hygienists and the National Safety Foundation, that make recommendations for safe and healthful practices in the workplace.

ARTHUR L. FRANK

(SEE ALSO: Asbestos; Carpal Tunnel Syndrome, Cumulative Trauma; Environmental Determinants of Health; Ergonomics; Farm Injuries; Mining; National Institute for Occupational Safety and Health; Occupational Lung Disease; Occupational Safety and Health; Occupational Safety and Health Administration)

BIBLIOGRAPHY

National Institute for Occupational Safety and Health (2000). Worker Chartbook, 2000. Washington, DC: NIOSH.