Exploring the Future of Occupational Health

Transcription

1 Exploring the Future of Occupational Health Trevor Peckham, MS, MPA Marissa Baker, MS Janice Camp, MSPH, MSN Joel Kaufman, MD, MPH Noah Seixas, PhD ASSE Health and Safety Summit October 4, 2016

2 To Discuss The Future of Occupational Health Project and its impetus Emerging themes impacting the OH field Proposed future directions/priorities for the field Proposed model for work and health Your thoughts!

3 Looking back 1970s Labor strong and other social movements on rise OSHA enacted OH studies: workplace/industry-based studies to investigate steel, rubber/tire, automobile, etc. Occupational exposures were high, potent Workforce large, stable ~13,000 worker deaths per year

4 Traditional model

5 Decline in injury and death rates/exposures Inhalation Exposures: reduction of ~10%/yr [+4 to -32%] (Creely, et al, Review of trends in inhalation exposure, 2007) Kromhout et al. presentation: Kromhout-Presentation-Session-7.pdf BLS, CFOI data

6 Future? Programs in industrial hygiene, occupational medicine, and occupational health nursing around the U.S. decline in program funding attracting a decreasing number of supporting faculty Potential shortfall of qualified professionals moving forward McAdams MT, Kerwin JJ, Olivo V, Goksel HA. (2011) National Assessment of the Occupational Safety and Health Workforce.

7 Future of Occupational Health Project GOAL: define and explore what the Future of Occupational Health may look like from research, training, and policy/management perspectives. Three components: An invited speaker series during to explore new trends influencing the field of occupational health and safety A cumulative symposium, held June 24-25, 2015 in Seattle. Ongoing research, course development, and community outreach on our findings

8 Speaker series and symposium

9 Emerging trends impacting OH Changes in work organization Globalization Changing workforce demographics Blurring of work and non-work factors Other trends Federal regulatory/policy logjam Decline in organize labor New investigative technologies Global climate change Increasing Wealth and Health Disparities

10 Organization of work Security Growing! Gig economy Flexibility

11 Fissured Workplace Term coined by David Weil, US Wage and Hour Administrator in US Dept of Labor Examples of fissuring: outsourcing, supply chain systems, contracting, day labor, labor suppliers, franchising, gig-economy Services like manufacturing, custodial, security, maintenance Even growing to include front desk staff, delivery drivers for packages, cell phone tower workers Three Impacts of the Fissured Workplace 1. Subsidiary companies providing services to lead businesses face pressure to reduce costs in order to win work (violations of federal and state minimum wage/overtime, workplace safety) 2. Splintering work activities across companies (often with ambiguously defined responsibility for safety) leads to holes in coordination 3. Widening income inequality

12 Gig Economy Gig economy Workers with gig work arrangements Independent contractors Office temps Pampered Chef/Avon Day Laborers Online gig economy Workers who utilize new technologies, markets, and platforms for alternative work arrangements Uber InstaCart Sharing economy Goods and services that are shared between consumers via online marketplaces AirBnB Car shares (car2go) ebay

13 OH&S Example: Temp Worker Injuries and Deaths Lawrence Daquan Day Davis

14 Globalization

15 Physical Mental Production Service Healthcare More small businesses More telecommuting New work plans New work conditions

16 Patterns of employment since 2000 UW, SPH, DEOHS Source. NYTimes, 9/29/16

17 Changing Demographics Older workers More women More turnover More chronic disease More immigrants

18 Chronic disease

19 Blurring of work and non-work Many of the most prevalent and significant health conditions in workers not caused solely by workplace hazards Examples include stress-related conditions, cardiovascular, psychological, and musculoskeletal disorders, obesity, depression, substance abuse, and violence Separation of work and non-work is in some ways artificial Compartmentalization leads to under-reporting The burden on workers and the nation is not just due to work, but the interaction of work and non-work factors.

20 A useful way to think of work and non-work factors related to workers comes through consideration of four conceptual models. [Schulte et al. 2012; Pandalai et al. 2013]

21 Model 1: Additive Interaction Occupational Risk Factor Personal Risk Factor Disease, Illness, or Injury Effect

22 Example: Additive Interaction Work-Related Physical Factors Musculoskeletal Disorders Age

23 Model 2: Effect Modification by Personal Risk Factor Personal Risk Factor Occupational Risk Factor Disease, Illness, or Injury Effect

24 Example: Effect Modification by Personal Risk Factor NAT2 Genotype Aromatic Amines Bladder Cancer

25 Model 3: Effect Modification by Occupational Risk Factor Occupational Risk Factor Personal Risk Factor Disease, Illness, or Injury Effect

26 Example: Effect Modification by Occupational Risk Factor Physical Activity at work Obesity Cardiovascular Event

27 Model 4: Separate Pathway Interactions Occupational Risk Factor Disease, Illness, or Injury Effect 1 Personal Risk Factor Disease, Illness, or Injury Effect 2

28 Example: Separate Pathway Interactions Noise Hypertension Smoking Coronary Heart Disease

29 Blurring of work and non-work

30 Productivity: Presenteeism Source: Hemp [2004]

31 Other important trends affecting OH&S Federal regulatory/policy logjam Decline in organize labor New investigative technologies Global climate change Increasing Wealth and Health Disparities

32 The impact of work and health Series of studies from Goh, Pfeffer and Zenios Linked national mortality/life expectancy statistics to employment conditions By groups defined by Gender, Race/Ethnicity, Education Estimated the risks associated with 10 employment determined factors Unemployment Health insurance Shift work Long hours Job insecurity Work family conflict Job Control Job Demands Social Support at Work Organizational Fairness

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35 How do we consider these trends? Traditional occupational health paradigm is a specific exposure leads to specific outcome among specific work groups Near separation of work-related risks from non-work risks What OH&S practitioners tend to focus on From what we ve already discussed, does this model fully encompass our field of occupational health and safety?

36 General directions moving forward Engaging those outside the field about work-related health issues Expanding academic research portfolios; and Development of improved, more broadly defined training for the professions in work and health.

37 Engagement Developing Interdisciplinary Networks across Academic Disciplines Engaging State and Local Government Engaging Community-based and Labor Organizations Engaging Industry in New Models of Worker Health Aligning with Current Social Movements

38 Broadening research portfolios Integrating a Broader Concept of Work-related Exposures and Risks Estimating the Burden of Work on Health and Well-being Leveraging New Investigative Technologies

39 Improving curriculum Strengthening Competencies of Graduates Incorporating Broader Social, Political and Legal Contexts

40 How do we consider these trends? Traditional occupational health paradigm is a specific exposure leads to specific outcome among specific work groups Near separation of work-related risks from non-work risks What OH&S practitioners tend to focus on From what we ve already discussed, does this model fully encompass our field of occupational health and safety?

41 NIOSH s Total Worker Health (TWH) Total Worker Health is defined as policies, programs, and practices that integrate protection from workrelated safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being.

42 TWH Examples of Integration Respiratory protection programs that simultaneously address tobacco use Ergonomic consultations and interventions that also cover joint health and arthritis management strategies Stress management efforts that first diminish workplace stressors and then build worker resiliency Integrated programs on topics addressing fall prevention, motor vehicle safety, first aid, hearing conservation, stretching and flexibility, and safe lifting for both work and community environments Schill and Chosewood 2012

43 Conflicting goals, an example Stress management efforts that first diminish workplace stressors and then build worker resiliency Where is the focus going to go if there are stressful work conditions? To altering the management style, reducing workload, increasing job rotation or rest breaks Or To conducting workshops on individual coping strategies and mindfulness training? Likely emphasis on the latter--removes responsibility from employer and places it on the employee

44 What s missing from this model?

45 A model of Work and Health 45

46 A model of Work and Health 46

47 A model of Work and Health 47

48 A model of Work and Health 48

49 Overall messages Work, and the workplace are key contributors to health, and locus for intervention to improve health of individuals, communities, and populations. Nature of work is changing and OHS concepts (and training/research programs) need to adapt.

50 Role of Safety Engineers? Anticipate, recognize, evaluate, impacts of new trends in OH Viewing the workplace as a locus for determinants of health Ability to consider work and non-work aspects? How do new production technologies and business practices fit in to this thinking? Safety through design, green production, product life cycle assessment, etc. Developing business case Intervention research Collaboration across professional networks

51 Questions? Thoughts? Trevor Peckham Forthcoming paper: Peckham et al., Creating a Future for Occupational Health. Annals of Work Exposures and Health.