Preventing Illness and Injury in the

Workplace

April 1985

NTIS order #PB86-115334
Recommended Citation:

Preventing Mness and Injury in the Workplace (Washington, DC: U.S. Congress, Office

of Technology Assessment, OTA-H-256, April 1985).

Library of Congress Catalog Card Number 84-601152

For sale by the Superintendent of Documents

U.S. Government Printing Office, Washington, DC 20402
Foreword

Congressional interest in work-related disease and injury led to the passage of the

Occupational Safety and Health Act in 1970. The Occupational Safety and Health Administration and the National Institute for Occupational Safety and Health were created

to administer that Act, which stated an ambitious goal: “to assure so far as possible

every working man and woman in the Nation safe and healthful working conditions. ”

This report responds to a request from the Chairman of the House Committee on

Energy and Commerce and a supporting letter from the Chairman of the Senate Committee on Labor and Human Resources. In this report, OTA examines three main topics:

identification of occupational hazards, including the available data on injuries and illnesses; development of control technologies for reducing or eliminating workplace hazards; and the incentives and imperatives that influence decisions to control hazards.

Workers, employers, health and safety professionals, and government officials have

all contributed to progress in this field. But improvements can still be made. More concerted effort and better use of existing methods would enhance hazard identification.

Further research could improve health and safety control technologies and contribute

to their incorporation in U.S. workplaces. Employers’ decisions to control hazards might

be fostered by changing the incentives and imperatives that affect those decisions.

In preparing this report, OTA staff drew upon the expertise of members of the assessment advisory panel and contractors, as well as other experts in the field of occupational health and safety. Contractors’ reports are available from the National Technical Information Service. In some cases, contractors’ opinions and viewpoints differ from

those in this report. Drafts of the final report were reviewed by the advisory panel,

chaired by Dr. Morton Corn; executive branch agencies, congressional staff, and other

knowledgeable individuals and groups. We are grateful for their assistance. Key OTA

staff involved in this assessment were Michael Gough, Karl Kronebusch, Hellen Gelband, Gwenn Sewell, and Beth Bergman. Denny Dobbin worked on this report while

on detail from the National Institute for Occupational Safety and Health.

Director

I l l
ADVISORY PANEL FOR PREVENTING ILLNESS

AND INJURY IN THE WORKPLACE

Morton Corn, Chair

Department of Environmental Health Sciences

The Johns Hopkins School of Hygiene and Public Health

Baltimore, MD

Duane L. Block

Ford Motor Co.

Dearborne, Ml

Richard F. Boggs

Organization Resources Counselors, Inc.

Washington, DC

Mark R. Cullen

Yale Occupational Medicine Program

Yale University School of Medicine

New Haven, CT

Philip E. Enterline

Graduate School of Public Health

Pittsburgh, PA

Melvin W. First

Department of Environmental Health Sciences

Harvard School of Public Health

Boston, MA

Matthew Gillen

Amalgamated Clothing and

Textile Workers Union

New York, NY

Melvin Glasser

Committee for National Health Insurance

Washington, DC

William J. McCarville

Monsanto Co.

St. Louis, MO

Wilbur L. Meier, Jr.

Dean, School of Engineering

Pennsylvania State University

University Park, PA

Samuel Milham, Jr.

Washington State Department of Social

and Health Services

Olympia, WA

Kenneth B. Miller

Workers Institute for Safety and Health

Washington, DC

Ted E. Potter

Shepherd Chemical Co.

Cincinnati, OH

Milan Racic

Allied Industrial Workers Union

Milwaukee, WI

Mark A. Rothstein

West Virginia University College of Law

Morgantown, WV

Marilyn Schule

Centaur Associates

Washington, DC

Michael O. Varner

ASARCO, Inc.

Salt Lake City, UT

James L, Weeks

United Mineworkers of America

Washington, DC

Roger H. Wingate

Liberty Mutual Insurance Co. (retired)

Mirror Lake Post Office, NH

John Mendeloff, Special Consultant

University of California—San Diego

La Jolla, CA
OTA PROJECT STAFF–PREVENTING ILLNES S

AND INJURY IN THE WORKPLAC E

Roger C. Herdman1 and H. David Banta, 2 Assistant Director, OTA

Jacqueline C.

Health and Life Sciences Division

Clyde J. Behney, Health Program Manager

Michael Gough, Project Director

Karl Kronebusch, Analyst

Denny Dobbin, Analyst 3

Hellen Gelband, Analyst

Gwenn Sewell, Research Assistant’

Beth Bergman, Research Assistant’

Virginia Cwalina, Administrative Assistant

Rebecca Erickson, Secretary/Word Processing Specialist

Carol Guntow, Clerical Assistant

Brenda Miller, Word Processor/P.C. Specialist

Contractors

Linda Starke (Editor), Washington, DC

Robert Arndt and Larry Chapman, University of Wisconsin

Margit L. Bleecker, The Johns Hopkins Medical Institutes

Corn, The Johns Hopkins University School of Hygiene and Public Health

Robert Goble, Dale Hattis, Mary Ballew, and Deborah Thurston, Clark University and

Massachusetts Institute of Technology

Philip J. Harter, Washington, DC

John L. S. Hickey, Carol H. Rice, and Brian A. Boehlecke, University of North Carolina

INFORM, New York, NY

Marthe Beckett Kent, Kensington, MD

Judith R. Lave and Lester B. Lave, Pittsburgh, PA

Douglas MacLean and Mark Sagoff, University of Maryland

W. Curtiss Priest, Massachusetts Institute of Technology

Jerry L. Purswell and Roger Stephens, University of Oklahoma

Springborn Management Services, Inc., Enfield, CT

Ruth Ruttenberg, Washington, DC

.—

‘From December 1983.

2Untll August 1983

‘Detallee from National Inst]tute for Occupational Safety and Health

‘June 1983 -Ju]y 1984

‘January-June 1983
Contents

Chapter Page

l. Summary and Options.....,,.....,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

2. Data on Occupational Injuries and Illnesses . . . . . . . . . . . . . . . . . . . . . . . . 29

3. Health Hazard Identification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

4. Safety Hazard Identification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

5. Technologies for Controlling Work-Related Illness . . . . . . . . . . . . . . . . . . . . . . . . . . 77

6. Technologies for Controlling Work-Related Injury . . . . . . . . . . . . . . . . . . . . . . . . . 103

7. Ergonomics and Human Factors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123

8. Personal Protective Equipment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143

9. Hierarchy of Controls ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175

10. Training and Education for Preventing Work-Related Injury and illness. . . . . . . . 189

11. A Short History of Private and Public Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . 205

12. Governmental Activities Concerning Worker Health and Safety . . . . . . . . . . . . . . . 219

13. Assessment of OSHA and NIOSH Activities . . . . . . . ,.. . . . . . . . . . . . . . . . . . . . . 257

14, Decisionmaking for Occupational Safety and Health:

The Uses and Limits of Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275

15. Incentives, Imperatives, and the Decision to Control . . . . . . . . . . . . . . . . . . . . . . . . 297

16. Economic Incentives, Reindustrialization, and Federal Assistance for

Occupational Safety and Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327

17. Preventing Work-Related Injury and Illness in the Future . . . . . . . . . . . . . . . . . . . . 345

Appendix A.–Supplemental Information on OSHA and NOSH. . . . . . . . . . . . . . . . . 359

Appendix B.—Working Papers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381

Appendix C.—Acknowledgments and Health Program Advisory Committee . . . . . . . 382

Appendix D.—Glossary of Acronyms and Terms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 386

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 423

vii
. . .

Summary and Options

.
Contents

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Associated Deaths, Injuries, and Illnesses . . . . . . . . . . . . . . . . .

Identification of Occupat ional Hazards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Technologies to Control Hazards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Training and Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 Dissemination of Health and Safety Information . . . . . . . . . . . . . . . . . . . . . . . . .

 Incentives and Imperatives That Influence the Decision to Control Hazards .

Reindustrialization and Workplace Health and Safety. . . . . . . . . . . . . . . . . . . . .

options for Controlling Workplace Hazards. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Data and Hazard Identification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Improved Control Technologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Education,Training, and Information Dissemination . . . . . . . . . . . . . . . . . . . . .

Incentives and Imperatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

The Role of OSHA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Creation of an Occupational Safety and Health Fund.. . . . . . . . . . . . . . . . . . . .

The Needs of Small Businesses . . .: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Assessing Health and Safety Programs.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4

4

6

7

1 0

11

11

15

16

1 6

1 8

1 9

21

2 2

2 4

2 5

2 6
—

1 ■

Summary and Options

Occupational hazards are not spread evenly:

Some workplaces, such as banks and offices, have

few hazards; manufacturing is more dangerous;

and mining and construction are comparatively

the most hazardous, Certain hazards—some chemicals and forms of radiation—are concentrated in

particular places of work; others—powerful machines and fast-moving machinery—are found

predominantly in manufacturing and construction. Each uncontrolled hazard is an opportunity

for preventing illness or injury.

The exact numbers of workplace-related deaths

and injuries are disputed, but OTA estimates that

there are about 6,000 deaths annually—about 25

per working day—due to injuries. Depending on

how injuries are counted, between 2.5 million and

11.3 million nonfatal occupational injuries occur

each year. Each working day there are about

10,000 injuries that result in lost work time and

about 45,000 that result in restricted activity or

require medical attention. There is so little agreement about the number of workplace-related illnesses that OTA does not take a position on the

controversy about the “correct” number. Most

deaths and injuries occur one at a time or in small

numbers in the Nation’s more than 4..5 million

workplaces.

OTA finds that controls for health and safety

are often developed for specific workplaces and

not disseminated to others. This results in duplication of effort as employers faced with the same

or similar problems are unaware of successful controls and thus do their own research and development. As well as being economically inefficient,

the unshared knowledge about controls may contribute to injuries and deaths.

Occupational hazards accompanied the industrial development of the Nation. In the 19th century, for instance, advances in manufacturing and

transportation exposed workers to new hazards,

including boilers, train couplings, and powered

saws, Scaldings, burns, missing fingers, hands,

and arms, and other injuries were the unplanned

consequences of work.

Because the relationship between these hazards

and injuries is usually immediate and direct, recognition of the hazards is relatively straightforward. The connection between occupational hazards and illness is more difficult to pin down.

Although a number of skin and respiratory diseases and some kinds of poisoning caused by

metals are definitely associated with work,

deciding whether other illnesses stem from

workplace exposures is difficult.

This century has seen some examination of the

role of the workplace in injury, illness, and death.

Motor vehicles used in work are involved in thousands of accidents, resulting in many injuries and

deaths. Construction remains a relatively dangerous trade: Powerful earth-moving and erection

machines, high scaffolding, and falling objects are

hazards continually faced by construction workers. Painful and sometimes incapacitating repetitive-motion disorders are associated with

assembly-line work. Chronic diseases, respiratory

conditions, and cancers have been linked with exposures to hazards in a variety of workplaces.

The control of workplace health and safety

hazards can be divided into three steps: hazard

identification, development of controls, and the

decision to control, The first two steps are largely

technical and require specialists. The third step

involves generalists, managers, and employers,

and may actually occur before hazards are fully

identified and controls are developed.

The control of illnesses and injuries is not the

sole purview of any particular sector of society.

Employers and employers’ associations, workers

and trade unions, universities, and the Federal and

State governments have initiated research directed

at identifying and controlling hazards, and all

have participated in decisions to control dangers

that have been identified. Federal involvement has

increased over the years, and in 1970 Congress

mandated a direct Federal role in all aspects of

occupational safety and health, including the setting of mandatory nationwide standards for safe

and healthful workplaces.

3
4 . Preventing Illness and Injury in the Workplace

The Chairman of the House Committee on

Energy and Commerce requested that the Office

of Technology Assessment undertake a study of

technologies to control occupational illnesses and

injuries. Both his letter and a supporting letter

from the Chairman of the Senate Committee on

Labor and Human Resources, called for a broadbased study. In addition to requesting examination of the general subject of control technologies,

the chairmen asked for evaluation of the available data and systems for collecting data about

work-related deaths, injuries, and illnesses; analysis of incentives and imperatives that influence

the decision to control hazards; and a discussion

of the opportunities for bettering occupational

health and safety as the country enters a period

of reindustrialization. Because of the many roles

given to Federal agencies by the Occupational

Safety and Health (OSH) Act, the activities of the

Federal Government are important to understanding developments and problems in designing, developing, and disseminating control technologies,

in collecting and analyzing data concerning occupational health and safety, and in providing

incentives and imperatives for the adoption of

controls.

The

●

report is organized in five parts:

This chapter summarizes the findings of the

report and presents the options for improving

FINDINGS

Occupationally Associated Deaths,

Injuries, and Illnesses

Currently available data are sufficiently accurate and comprehensive to describe the approximate number of occupational injuries and deaths

due to such injuries, although these data are still

limited and, in particular, offer little guidance for

prevention. Data about occupational illnesses are

far less accurate and comprehensive.

Deaths

The National Safety Council (NSC, a private

organization) and the U.S. Bureau of Labor Statistics (BLS) of the Department of Labor compile

●

●

●

●

occupational health and safety that have been

developed during this assessment.

Chapters 2, 3, and 4 describe the data available on workplace deaths, injuries, and illnesses and discuss methods for identifying

health and safety hazards.

Chapters 5 through 10 consider various control technologies and current efforts to train

and educate employers, managers, employees, and health and safety professionals.

Chapters 11 through 16 discuss the factors

that are involved in the decision to control

hazards. They review the activities of Federal agencies, the role of economic analysis

in decisionmaking, the influence of various

incentives and imperatives on decisionmaking, and the opportunities for installing controls during a period of reindustrialization.

Chapter 17 looks at opportunities for preventing occupational injury and illness in the

future.

(The contractors’ reports and OTA working

papers prepared for this assessment are available

through the National Technical Information Service of the U.S. Department of Commerce. )

data about occupationally related deaths.

most reliable estimates are derived from the

The

BLS

Annual Survey, although the survey data do not

include the Nation’s entire work force. OTAs adjustment of the BLS figures yields an estimate of

about 6,000 deaths annually from occupational

injuries, or about 25 deaths each working day.

Occupational fatalities usually occur as isolated

events that kill only one or, at most, a few workers and attract little publicity.

Currently collected data can be used to identify the most hazardous industries and the types

of accidents that most commonly result in death.

The most dangerous industry is mining, which

had 44 fatalities per 100,000 full-time workers in
Ch. 1—Summary and Options ● 5

1982. It was followed by the construction, agriculture, and transportation industries (29, 28, and

22 fatalities per 100,000 workers, respectively).

Falling below the all-industry average of 7.4 per

100,000 are manufacturing, wholesale and retail

trade, and the service industries, all of which had

about 4 fatalities per 100,000 workers. The finance, insurance, and real estate industries had

the lowest rate of about 2 fatalities per 100,000

workers.

BLS data show that about half of the fatal occupational injuries involve motor vehicles, offthe-road industrial vehicles, and falls. Complementing those findings, an examination of every

on-the-job fatality in the State of Maryland during 1 year found that transportation vehicles, nonroad vehicles, and gunshots were the leading

causes of fatal injuries. Truck drivers were the

most frequent victims of transportation vehicle

accidents; most gunshot deaths occurred during

holdups.

Injuries

The OSH Act requires employers to keep records of: 1) injuries that caused 1 day or more’s

absence from work or “restricted activity” at

work, and 2) injuries that required medical attention but caused less than a day of missed work.

BLS estimates that in 1983 there were 2.1 million

“lost-workday” injuries and 2.6 million “medical

treatment” injuries in the private sector, which

covers about three-fourths of the work force. Injuries to Federal, State, and local government employees may add another 0.4 million lost workday injuries and 0.5 million medical treatment

cases. Adding those numbers, there were approximately 5.6 million occupationally related injuries.

The National Center for Health Statistics (NCHS),

which uses different definitions for injuries and

prepares estimates for the entire work force, estimates a total of 11.3 million occupationally related injuries in 1981.

BLS and NCHS have separately estimated that

workplace-related injuries lead to the loss of, respectively, 36.4 million and 60 million to 70 million days of work annually. Projections from

NCHS data are that workers spend about 44 million days in bed because of disability and have

over 200 million days of restricted activity. The

NSC has estimated that for 1980 the total costs

of work injuries amounted to $30.2 billion.

The leading types of disabling, nonfatal injuries

are overexertions (largely injuries to the back),

which occur in many industries. Injuries in manufacturing and construction often involve moving machinery and falls.

Illnesses

Three factors generally contribute to incomplete

recording of occupational illnesses: 1 ) many occupational diseases are indistinguishable from

nonoccupational illnesses, 2) the occupational

causes of diseases are often not recognized by

employers and employees, and 3) diseases with

long latencies often occur after employment or exposure has ceased. Thus the BLS Annual Survey

estimate of 106,000 such illnesses in 1983 consists

mostly of diseases, such as acute dermatitis, that

are easily diagnosed and readily connected with

workplace exposures. Serious diseases—respiratory and necrologic disorders and cancers—are

not generally captured in the BLS records of

workplace-related illnesses.

Arguments about the number of occupationally

related diseases may obscure the important fact

that occupational illness is preventable. For instance, a decade-long debate about the number

of occupational cancers has been resolved to most

people’s satisfaction, and it is generally accepted

that occupational cancers represent something like

5 percent (20,000 annual deaths) or less of all cancer deaths. The more important considerations are

that workers in some industries have borne and

still bear a disproportionate amount of risk and

that, once causes of occupational disease are identified, controls can be adopted to reduce risks.

Some Caveats on Available Data

Accurate data are necessary to know the magnitude of the workplace health and safety problem, to target prevention programs, and to assess

the progress in controlling illnesses and injuries.

Many factors other than control programs, however, can influence the number of illnesses and

injuries. For instance, it has been known for some

time that injury rates fall during periods of high

unemployment because younger, less skilled workers are laid off first and there is more time for
6 ● Preventing Illness and Injury in the Workplace

maintenance of plant and machinery. OTA finds

that the slowdown in business activity between

1980 and 1983 was the most important factor in

the decrease in injury rates during that period.

Moreover, national injury rates are related to the

level of business activity, going up as business expands, down as it contracts. The Occupational

Safety and Health Administration (OSHA), on

the other hand, points to these declines as a measure of the success of its new programs that emphasize a cooperative approach between the agency

and employers.

Over the last decade the identification and control of health hazards, especially of substances suspected of causing cancer, has received much attention. Yet the available data about workplace

diseases, even if accurate, would not yet reveal

any effects from a recent reduction in exposures

to carcinogens, Given the long time between exposure to cancer-causing substances and development of the disease, years or decades may pass

before cancer rates are affected. An even greater

problem in relying on figures in this area, however, is the inaccuracy of occupational illness

data. In 1981, only 234 occupational cancers were

reported to workers’ compensation systems in 29

States, which contain about half the Nation’s

work force. That number can be compared to the

4,000 to 12,000 cancers that are estimated to occur from asbestos exposure alone.

Identification of Occupational Hazards

Health

Toxicology, occupational medicine, and epidemiology provide the means for identifying the

chemical, physical, or biological causes of occupational illnesses. Identifying an association or possible association between an exposure and disease

often ignites a dispute. Employers, who have investments to protect and are perhaps reluctant to

accept the idea that employees have been harmed,

will require more evidence than workers seeking

an explanation for disease among them. It is clear

from these controversies that the results of toxicologic texts often lead to further study rather than

efforts to control a hazard; that physicians’ reports

of associations, depending on the disease and exposure, may or may not be accepted as convincing; and that epidemiologic evidence linking exposures and disease is most convincing.

The traditional role of toxicology has been to

provide information about the mechanisms of disease causation. Especially since the late 1960s,

however, toxicology has been used to investigate

chemicals in an attempt to predict their effects in

humans. The bulk of the effort has been directed

toward identifying chemical carcinogens, but

some attention is now being directed toward

necrologic and reproductive health hazards.

Physicians, both those who specialize in occupational medicine and those in private practice,

have identified many health hazards. As an example, reports of asbestos-associated lung cancer cases in the 1930s were an early clue about

that occupational hazard. More recently, a physician noticed an excess of liver cancers in vinyl

chloride workers. His observation led to a very

successful effort to reduce exposures to that substance. Importantly, physicians speak to workers, and it is workers who are often the first to

be aware of hazards.

Epidemiology, the systematic investigation of

possible associations between exposures and diseases, has confirmed important suspicions about

work-related illnesses. The now universally acknowledged case against asbestos, for example,

rests on epidemiologic studies. Positive epidemiologic results showing that an exposure is associated with a disease are the most convincing evidence of a substances toxic effect. Unfortunately,

the power of epidemiology to detect small risks

is limited, and evidence obtained from toxicology

that a substance is toxic can often be neither confirmed nor denied by epidemiologic studies.

The National Institute for Occupational Safety

and Health (NIOSH) conducts various epidemiologic investigations and also makes Health Hazard Evaluations (HHEs), short-term studies conducted in response to private and public sector

employee or employer requests. HHEs are designed to “determine the toxic effects of chemical,

biological, or physical agents . . . in the workplace through medical, epidemiologic, and industrial hygiene investigations.” HHEs, which become public reports, have identified and verified

the workplace origins of some illnesses.
Ch. l—Summary and Options . 7

Information that could be useful for generating and examining hypotheses about relations between exposures and health effects is currently collected by some industries, but it is not clear that

the data are often analyzed and the conclusions

used to decide upon controls. Even data collected

by the Federal Government are not used as much

as they could be. Useful data are collected by different agencies, but concerns about individual

privacy have restricted linking data from different

sources. Although several committees of government scientists have explored ways to remove the

restrictions, little has been done.

Safety

The idea that “unsafe workers” are a major contributor to injuries has hampered efforts in injury

prevention. In the 1920s, a researcher concluded

that nearly 90 percent of injuries were due to

workers’ “unsafe acts” and 10 percent to “unsafe

conditions. ” Although this ratio of “unsafe acts”

to “unsafe conditions” is often referred to, it is

not supported by other research. Unfortunately,

efforts are still made to separate injury causes into

“unsafe acts” and “unsafe conditions, ” while

neglecting the often complex interactions between

workers and machines that can lead to injuries.

Additional efforts to apply epidemiologic techniques to injury analysis should be encouraged.

Technologies to Control Hazards

A generalized model of occupational injury and

illness is derived from the public health model of

infectious disease transmission. The model has

three parts: sources of hazard, transmission of the

hazard, and workers. Methods for controlling

workplace illnesses and injuries are intuitively

simple. Health and safety professionals generally

follow a “hierarchy of controls” approach that is

related to this general model:

first, containing the hazard—whether it is a

substance or some physical, electrical, or mechanical energy —at its source;

second, interfering with transmission of the

hazard to the worker; and

third, providing the worker with protective

clothing and equipment.

The first two types of controls, controlling at the

source and controlling transmission, are commonly called “engineering controls. ”

Controlling Health Hazards

Control at the source can be accomplished by

design or modification of process or equipment

or by substitution of less hazardous materials.

This approach offers the greatest opportunist y for

prevention, especially when incorporated in the

initial installation of equipment into a plant. For

example, redesigned dry-cleaning equipment eliminates the need for someone to transfer chemically

treated clothes from one machine to another and

thus prevents worker exposure to that particular

chemical. Similarly, the very successful control

of vinyl chloride exposures involved process

changes that reduced the number of times workers’ had to clean reaction vessels, thus lowering

exposures during maintenance operations. An illustration of control by substitution is the use of

steel shot instead of sand in abrasive blasting operations. This eliminates worker exposure to silica

dust, which can lead to silicosis.

Ventilation is the method most often used to

control transmission of health hazards. Local exhaust ventilation uses an air stream to remove

contaminants from work areas. Familiar examples

of this include laboratory fume hoods and the

local exhausts above many kitchen ranges. Similar devices are installed for many types of workplace hazards. General dilution ventilation reduces worker exposure by supplying “fresh” air

to the workplace and usually involves the heating/air-conditioning systems of a plant. These systems can be modified to increase the amount of

airflow and thus dilute airborne hazards. Recent

changes in building ventilation aimed at conserving energy use air recirculation techniques.

If not done properly, some of these altered systems may increase worker exposures.

Other ways to control transmission include isolating the source and preventing toxic materials

from becoming airborne. Worker exposures to asbestos and cotton textile dust were reduced by

enclosing dusty carding machines. More generally, automating processes and locating equipment
8 Preventing Illness and Injury in the Workplace

in rooms or buildings away from workers reduces

exposures. A common technique for preventing

dust from becoming airborne is to spray water

on the material.

Finally, control at the worker may include administrative procedures, work practices, and the

use of personal protective equipment. Administrative procedures include worker rotation among

jobs to reduce the number of people exposed fulltime, as well as the scheduling of jobs and processes that generate hazards at times when few

workers are present. Work practices are simply

job procedures and methods that are designed to

reduce hazards. Personal protective equipment,

such as hard hats and respirators, are described

in more detail below.

Controlling Injury Hazards

Workplace injuries generally involve transfers

of energy, and thus controlling them could be approached as a task of preventing the transmission

of energy. For example, mechanical energy can

be transmitted to stationary workers by falling

objects, such as bricks on a construction site. Controls could involve securing the bricks so they do

not fall, setting up overhead barriers to prevent

any falling bricks from striking workers, and

issuing hard hats to the workers.

However, the terminology, analytical methods,

and procedures of safety professionals have usually differed from those used in controlling health

hazards. Safety engineers have tended to use

codes, standards, and models of “good practice”

that are oriented around particular topics: fire prevention, electrical safety, machinery design, plant

layout, etc.

Recommended “good practice” often involves

common sense and the personal experience of

safety engineers, with relatively little scientific

analysis, systematic data collection, epidemiology, or experimental research. In addition, as

mentioned, the view that many or most injuries

are due to so-called unsafe acts has interfered with

the incorporation of injury controls into the design of plant and equipment.

Nevertheless, injury prevention can be incorporated into the design of workplaces. Controls

can be introduced to prevent electrical shocks,

falling objects, the collapse of buildings and

trenchs, and workers falling or being crushed by

machinery and equipment.

Manufacturing involves the application of

energy to materials to shape them into usable

products. Woodworking, hot metalworking, and

cold metalworking are three processes with significant hazards. A number of traditional control

techniques are available to reduce these hazards.

These include the installation of guards to prevent hands and fingers from getting caught in machinery and material from flying out and striking workers. Machinery and processes can also

be redesigned to minimize the need for workers

to place their arms or legs near moving machinery parts. Interlocks and two-hand controls are

available to prevent machine operation when

guards have been removed or when a worker’s

hands are inside the machine. Finally, personal

protective equipment, such as face shields and

goggles, are available to reduce the risk of injury

from flying objects.

Fires and explosions cause deaths and injuries

as well as large economic losses. For both those

reasons, efforts to prevent them have resulted in

careful attention to good plant design, control of

the ignition sources of fires, installation of warning alarms and systems to extinguish fires at early

stages, and plans for quick evacuation of burning buildings.

Finally, employers often set up formal injury

prevention programs. Because management has

the primary responsibility for prevention of workrelated injury and illness, a successful program

must start with a strong commitment from management. The stronger the commitment at the top,

the greater the likelihood of success. Typical management efforts to prevent work-related injury include establishing company policies, incorporating injury prevention into plant design, carefully

investigating reported injuries to identify hazards,

keeping accurate and comprehensive records,

placing workers in appropriate jobs, and conducting safety training for workers and supervisors.

Personal Protective Equipment

Hard hats, safety shoes, and protective eyewear

are examples of personal protective equipment.
. —— —

Ch, l—Summary and Options . 9

—

In many cases, especially construction, there are

no practical engineering substitutes for such devices. Respirators and hearing protectors guard

against hazardous dusts, fumes, vapors, and loud

noises.

Obviously, personal protective devices must be

worn to be effective, and their successful use requires both that equipment and instruction be

made available and that use be properly supervised. There is evidence that safety equipment,

such as hard hats and safety toe shoes, is worn

when required by employers. Because of the clear

connection between those devices and injury prevention, it is reasonably easy to argue that safety

equipment will provide immediate benefits. On

the other hand, the value of wearing a respirator

to protect against a disease that may not manifest itself for several years or a few decades may

not be as immediately clear. In addition, most

respirators and hearing protectors are uncomfortable and hamper communication, and respirators

make breathing more labored. Finally, there is a

body of engineering knowledge that can be applied to reducing or eliminating the need to use

respirators and hearing protectors.

Unlike engineering controls that are often tailored to a particular workplace, personal protective equipment is manufactured and sold for use

at many diverse sites. Some Federal regulations

require the use of personal protective equipment.

There are, however, no Federal standards for its

performance (with the exception of respirators);

instead, the Government relies on manufacturers

to produce and sell equipment that meets standards adopted by voluntary standards organizations, The American National Standards Institute

(ANSI) is the source of most such standards.

In the mid-1970s, NIOSH purchased samples

of personal protective equipment and tested them

against ANSI standards. Many items failed. For

instance, the lenses on 11 of 24 models of a type

of protective eyewear splintered or shattered when

subjected to the ANSI test for impact resistance;

only 4 of 19 models of hard hats passed all the

ANSI-specified tests. These results are especially

discouraging because the employer who purchases

the equipment and the workers who depend on

it must rely on the manufacturer to produce a

good product.

The standards, often not met, are themselves

limited. Plastic lenses are tested for resistance to

penetration, whereas glass lenses are not; NIOSH

commented that it would expect most glass lenses

to fail the test if it were required. Similarly, hard

hats are tested for resistance only to vertical impacts. No tests are required for off-center impacts.

The only type of personal protective equipment

that is tested and certified by the Federal Government is respirators. NIOSH certifies respirators

using laboratory test methods that, in some cases,

were developed years ago. Efforts to update the

certification requirements have progressed slowly

and may take years to complete.

The few tests carried out in the workplace under

conditions of normal use show that respirators

often do not provide the level of protection expected from the laboratory measurements. The

poorer performance may be due to inappropriate

use or maintenance or overestimation of performance based on laboratory tests.

The Environmental Protection Agency (EPA)

formerly required that hearing protectors be rated

for effectiveness. The effectiveness of probably

all hearing protectors is overrated because of systematic errors in tests conducted to comply with

the EPA requirements.

Hierarchy of Controls

Using engineering solutions to control hazards

at their source or in the pathway of transmission

is more reliable and less burdensome to the worker

than personal protective equipment, Once installed, these controls work day after day with

minimum routine intervention beyond maintenance and monitoring.

In keeping with the tenets of professional organizations such as the American Industrial Hygiene

Association and the American Conference of

Governmental Industrial Hygienists (ACGIH),

OSHA had permitted use of personal protective

equipment only when engineering controls were

not feasible, not capable of reducing exposures

to the required levels, or in the process of being

designed and installed. This approach has been

criticized by some employers who argue that they

should be able to substitute personal protective

equipment more freely for other types of controls.
10 . preventing Illness and Injury in the Workplace

In 1983, OSHA announced its intention to reconsider its policy of relying first on engineering

controls for airborne health hazards. In a more

specific action, OSHA in 1984 proposed a reduction in permissible exposure to asbestos. The

agency proposes to allow the use of respirators

to attain the new standard. If this regulation becomes final, it will almost certainly provide an

argument for primary reliance on respirators in

meeting other standards. Such a change must consider the poor results attained with those devices.

OTA’s analysis of the literature indicates that

respirators provide the protection that is claimed

for them only in workplaces that provide scrupulous supervision of maintenance and use. Those

conditions are rare. To turn away from the hierarchy of control without careful verification of the

levels of protection afforded by personal protective devices is likely to increase exposures to

health hazards.

Training and Education

OTA finds that programs to educate workers

and health and safety professionals have rarely

been evaluated, and that evaluation is necessary

to know about their effect. Although not supported by evaluation, there appears to be general

agreement that they succeed. Evaluation is difficult because of the difficulty in determining what

causes changes in illness and injury rates. Nevertheless, such efforts should be encouraged.

NIOSH funds Educational Resource Centers

(ERCs). The centers are to educate occupational

health and safety professionals, to offer continuing education programs, to conduct research, and

to provide regional consultation services. They

are required to provide interdisciplinary education with contributions from occupational medicine and nursing, industrial hygiene, and safety

engineering. These requirements set ERCs apart

from other health and safety professional education programs.

In 1981, with $12,1 million funding, the ERCs

graduated over 780 professionals from degree programs and trained over 12,000 professionals in

continuing education programs. Since then the

President’s budget has proposed cutting the ERC

funding to zero, and Congress partially restored

funding to $5.8 million in both fiscal year 1982

and 1983. Decreases in Federal funding will probably result in fewer degree and training programs.

Large companies with successful programs emphasize that commitment to control of workrelated injury and illness must begin with top

management. Despite that widely held opinion,

little attention is given to injury and illness prevention in the education of business administration students. One attempt at building manager

awareness, the NIOSH and OSHA Project Minerva,

is sponsoring a series of meetings for business education teachers to introduce them to the concepts

of occupational health and safety and to find ways

of bringing those concepts into their courses.

The Nation’s engineering schools annually train

nearly 400,000 students. The accrediting organization for engineering schools requires, in theory,

that engineering design courses consider health

and safety. These courses, in which students learn

the fundamentals of designing plants and processes, would appear to be especially appropriate

for learning about the control of hazards. The

topic apparently receives little attention, however.

At one major engineering school, for example,

most faculty interviewed agreed that safety was

important, but few hours were devoted to teaching it,

The engineering curriculum, which prepares

students for a professional license at the baccalaureate level, is acknowledged as one of the

most course-laden programs at a university. Although adding instruction in health and safety is

attractive, it is difficult to fit this instruction into

the existing engineering curriculum.

Educating physicians about occupational medicine falls into two categories: general education

about occupational disease and injury, and specialized training for practitioners of occupational

medicine. Improvements can be made in both

areas. It is generally accepted that physicians in

general practice fail to recognize the impact of occupational factors on the health of their patients.

This poor recognition stems from an orientation

toward occupational health that is minimal at best

and often nonexistent in U.S. medical schools. To

accommodate classes on occupational medicine

in the crowded medical curriculum would require

that other subjects be dropped, a difficult task.
Ch. 1—Summary and Options ● 1 1

Postgraduate, specialty training in occupational

medicine has traditionally been subsumed under

preventive medicine, centered in schools of public health, and sometimes criticized for providing

too little clinical experience. The criticism is being muted by the requirement of clinical experience for board certification of physicians in occupational medicine.

Dissemination of Health and

Safety Information

Much information about hazards and controls

is available from NIOSH, OSHA, health and

safety professionals’ associations, and the trade

literature. The volume and unorganized state of

this information impede its use. As a start in making information more accessible, NIOSH and the

National Library of Medicine have established

computerized data systems that provide useful information for evaluating workplace hazards.

OSHA has a consultation program that is designed to provide assistance in hazard identification and control to employers, especially those

who run small businesses. It is a potentially valuable tool for the dissemination of information

and may be a way to improve job conditions that

is less adversarial than the enforcement of regulations through inspections. In fiscal year 1983,

OSHA funded consultations in more than 30,000

workplaces.

To date, OSHA has not evaluated the effects

of the consultation program on injuries and exposures. Although OSHA urges that employers

share the consultants’ information with employees, this step is not required, and it is probable

that workers are sometimes not informed. Some

observers have expressed concern that funding for

consultative visits diverts resources from OSHA

inspection activities.

Letting workers know about occupational

hazards is now facilitated and required by State

and local “right-to-know” laws and the recently

issued OSHA rule concerning the labeling of containers of hazardous chemical substances. Such

information is valuable not only to workers but

also to owners and managers who purchase chemicals for their businesses and to doctors and other

health professionals,

Incentives and Imperatives That Influence

the Decision to Control Hazards

Increased knowledge of hazards and improved

controls provide the means for protecting health

and safety, but a decision to adopt the controls

is necessary for them to have any impact at all.

In fact, the first and most important act in workplace health and safety may be the decision to control

the

●

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0

●

●

●

●

hazards. At least seven factors may motivate

decision to control:

employers’ enlightened self-interest,

information on hazards and controls,

financial and tax incentives,

workers’ compensation and insurance,

tort liability,

employees’ rights and collective bargaining,

and

regulation.

The first six factors can be viewed as incentives;

the last, regulation, is an imperative. OTA finds

that while each of these may motivate a decision

to control, the influence of all the incentives and

the imperative is limited.

Employers’ Enlightened Self-Interest

An important motivating factor behind voluntary employer actions concerning health and safety is enlightened self-interest and concern for other

humans, Reinforcing such voluntary efforts are

reductions in the costs of absenteeism, workers’

compensation, or medical care when the decision

to control hazards results in fewer injuries and illnesses.

OSHA has recently instituted several programs

to encourage voluntary hazard control. In several States, employers are exempt from programed

inspections if they receive an OSHA consultation

and thereafter correct all serious hazards. OSHA’s

Voluntary Protection Program also encourages

voluntary actions.

Some employers also participate in cooperative

efforts to develop voluntary standards that draw

upon the collective information and expertise of

companies in a particular industry, trade association, or standard-setting organization. Voluntary

standards are an important source of information

for employers, workers, and Government agen-
12 . preventing Illness and Injury in the Workplace —

cies, and they may move all companies that agree

to them to a common performance level.

However, voluntary standards are also criticized for being insufficiently protective. Suggested

remedies include having additional input from labor unions and the public when standards are

drafted. Yet unions and public interest organizations frequently lack the staff and other resources

to participate in voluntary standard-setting. Furthermore, they often do not want to participate

because of a history of industry domination and

the unenforceable nature of voluntary standards

The pressures of the competitive marketplace

substantially limit the ability of individual

employers to improve employee health and safety

through voluntary actions. If a company devotes

its resources to improving workplace conditions

but its competitors do not, the firm can find itself

at a disadvantage.

Information on Hazards and Controls

Timely and accurate data are necessary for

making decisions, and both Government and private organizations provide information about

hazards and controls. Although necessary, information alone may have little influence on decisions to control.

Financial and Tax Incentives

Reducing the costs of purchasing needed equipment and technology can encourage employers

to improve health and safety. Four kinds of tax

and assistance programs might be useful for occupational health and safety: investment tax

credits, accelerated depreciation allowances, direct subsidies, and Government loan programs.

Funds from a Government loan program for small

businesses have been used for occupational health

and safety investments, but that program was

abolished in 1981. The other three mechanisms

have been used to encourage investments in equipment for environmental protection, but not for

health and safety controls.

tion of injuries and illnesses is a secondary goal.

Although workers’ compensation programs have

probably had a positive effect on injury experience, empirical evidence for this has been difficult to gather.

Four factors limit the incentives that workers

compensation can provide for control of hazards.

First, all insurance schemes spread losses; therefore, the insurance function of workers’ compensation means that employers who cause injuries

do not bear their full costs, unless they are selfinsured or pay premiums that are directly tied to

their injury and illness experience. Second, benefit levels represent less than the full social costs

of injuries and illnesses. Third, some injuries and

most illnesses are not compensated because a

claim is never filed, or they are inadequately compensated because the claim is delayed or denied.

To the extent that these factors reduce the fraction of the costs of injuries and illnesses that are

borne by employers, they reduce incentives for

prevention. Changes in the system that lead to

a greater proportion of the costs of illnesses and

injuries being paid by employers would enhance

the prevention incentives of workers’ compensation,

Tort Liability

The last decade has seen spectacular growth in

the number of cases in which workers sued firms

that manufactured machinery and other products

purchased by employers for workers’ use, Such

suits are generally filed against “third parties, ”

manufacturers and suppliers, because workers’

compensation programs bar suits against employers.

Tort liability has received special attention because of the number of third-party lawsuits

against suppliers of asbestos. If the number of

third-party suits increases, and if they are successful for hazards other than asbestos, they may become an important incentive for prevention. Even

so, the number of cases may be limited because

it is difficult to produce the degree of proof required by courts in cases of occupational disease.

Workers’ Compensation and Insurance Employees’ Rights and Collective Bargaining

The primary goal of workers’ compensation The OSH Act created opportunities for worker

programs is to pay injured workers’ medical ex- participation in health and safety activities. The

penses and to compensate for lost wages. Preven- act provided that workers can:
—.

Ch. I—Summary and Options ● 13

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●

request OSHA inspections,

participate in the conduct of an OSHA inspection,

participate in any of the stages of a proceeding before the Occupational Safety and

Health Review Commission,

contest the “reasonableness” of the abatement

date set by OSHA,

participate in standards development and the

issuance of variances, and

request a Health Hazard Evaluation from

NIOSH.

In addition, the act established a mechanism to

protect employees from job discrimination for

having exercised any of these rights. This provision prevents discrimination against employees

who refuse work that presents an imminent danger of injury, although it probably does not extend to employees who refuse work that the

worker thinks presents a health hazard.

Collective bargaining is particularly useful for

establishment-specific implementation of controls

and for monitoring employer actions. It is severely

limited because only about 20 percent of the work

force is unionized and because not all unions have

sufficient staff expertise in industrial hygiene, injury prevention, or occupational medicine. Moreover, health and safety provisions must compete

with other bargaining issues for attention and resources. Some people object to collective bargaining for injury and illness prevention because they

believe that health and safety on the job ought

to be an employee right, not subject to negotiation.

At least 82 percent of union contracts contain

at least one clause related to health and safety

according to data collected by the Bureau of National Affairs, Unions can encourage members’

participation in health and safety activities, participate in worker education in hazard recognition, provide or have access to technical expertise, and establish mechanisms for dispute

resolution between employer and union,

OSHA Regulation

Mandatory Federal regulations are an imperative for the adoption of controls. Labor representatives insist on mandatory standards and employer representatives, especially health and safety

professionals, accept the need for them. Most of

the standards set by OSHA, however, have been

criticized by nearly all parties, but for different

reasons. Labor groups judge the standards as insufficient to protect health. Business groups see

them as nit-picking, excessively stringent, unnecessary, inflexible, and too costly. The criticisms

from both sides in part reflect fundamental differences concerning the desirable level and type

of Federal intervention in this area.

OSHA’s Standard-setting Criteria.–Since 1981,

OSHA has used four criteria for decisions on

health standards. First, it determines if the hazard in question poses a “significant risk” and warrants regulatory intervention. Second, the agency

determines whether regulatory action can reduce

the risk. If so, OSHA develops a standard to reduce the risk “to the extent feasible, ” considering

both technological and economic feasibility. Finally, OSHA analyzes the cost effectiveness of various options to determine which will achieve its

chosen goal most efficiently.

All OSHA regulatory actions are now reviewed

by the Office of Management and Budget (OMB)

under Executive Order 12291, which, to the extent permitted by law, requires regulatory agencies to demonstrate that their proposed and final

regulations pass a cost-benefit test. Generally

speaking, the results of the OMB review and

agency responses have not been made public,

making it difficult to determine if OSHA decisions

have been altered by OMB’s cost-benefit review.

OSHA’s Record of Standard Setting.—There

is dissatisfaction about the length of time OSHA

takes to develop, propose, and promulgate new

standards or revisions of existing standards. In its

first 13 years, through December 1984, OSHA

issued only 11 new or revised health standards

concerning 24 specific chemical substances and

one standard covering exposure to noise. Standards for two of the substances and noise were

overturned by the courts. Twenty-six new or revised safety standards were completed. In addition, broader regulations concerning employee access to records, a “generic” policy concerning the

regulation of carcinogens (under which no substance has been regulated), and the labeling standard were issued.
14 . Preventing Illness and Injury in the Workplace

In part because of the slowness of OSHA standard writing, many OSHA standards seriously lag

behind recommendations and voluntary standards

issued by professional societies and voluntary

standards organizations.

Most current OSHA health standards are based

on the exposure limits published by the American Conference of Governmental Industrial Hygienists in 1968, and most safety standards rely

on American National Standards Institute publications of the 1960s. Those standards were

adopted in 1971 under a section of the OSH Act

which gave OSHA authority to adopt established

Federal standards and national consensus standards. ACGIH annually updates its limits, including standards for additional chemicals, and

often recommends stricter exposure limits. OSHA

often does not follow suit.

OTA finds that ACGIH exposure limits and

NIOSH recommendations, overall, are stricter

than the OSHA standards. In addition, the 1968

ACGIH list covered nearly 400 substances. The

current ACGIH list covers over 600 substances,

but OSHA’S list—with a handful of additions—

remains essentially the same as ACGIH’s 1968 list.

A mechanism for timely and efficient OSHA consideration of new ACGIH exposure limits and

NIOSH recommendations might prevent OSHA

from lagging behind professional recommendations.

OSHA Inspection and Enforcement.—A regulatory strategy will succeed only if the agency’s

enforcement efforts have adequate resources. For

most establishments the probability of a routine

OSHA inspection is very low (there are about

160,000 inspections annually in a total of 4,600,000

workplaces). Most inspections take place in manufacturing or construction. But even in those industries, on average, a plant or site will be inspected only rarely. For example, the typical

manufacturing establishment can expect to be inspected once every 6 years. In addition, even if

an employer is found not to be in compliance, the

fines issued by OSHA are small, especially when

compared with the costs of many types of controls. For example, the average proposed penalty

for employer violations that threaten “death or

serious physical harm” is less than $200,

The current administration has implemented a

number of changes in inspection and enforcement.

A new type of inspection examines only the employer-maintained injury records if the firm’s

injury rate is below the national average for manufacturing. In addition, the number and percentage of inspections with “serious” and “willful”

violations has fallen, and the total dollar amount

of proposed penalties has been reduced substantially.

Other new OSHA policies encourage area directors and employers to “settle” citations by reducing or eliminating penalties in return for an

employer’s promise to abate the hazard and to

comply with OSHA regulations. These changes

may decrease the contentiousness of some OSHA

proceedings. On the other hand, they may have

further reduced an already weak regulatory effort.

OSHA’s Effects. —The impact OSHA can have

on injury rates is constrained by the small size of

the OSHA regulatory effort, which can inspect

less than 4 percent of the Nation’s workplaces

annually. Most evaluations have searched for

OSHA’s effects on total injury rates, which could

be masking the success of the agency in preventing certain specific types of injuries as well as possible differences in the effectiveness of each area

office of OSHA and of the 25 jurisdictions operating “State programs. ”

The research results are mixed. Several researchers have found favorable, but generally

small, changes, implying that OSHA activities

have reduced injury rates. Other researchers have

not found any significant correlation between

OSHA activity and workplace injuries.

Currently, OSHA points to decreasing injury

rates for 1980 through 1983 as evidence that the

agency’s new regulatory approaches are paying

off. However, changes at OSHA could not fully

account for the declines, for they were not instituted until 1981, more than a year after the drop

in rates began. Moreover, as indicated earlier, the

economic recession, including increased unemployment and a shift away from “smokestack industries, ” is the most important factor behind this

decline.
Ch. l—Summary and Options ● 1 5

There is some evidence that several OSHA regulations have had a positive effect on exposures

to health hazards. The best known case is vinyl

chloride. Exposures declined dramatically after the

issuance of a more stringent OSHA standard.

Substantial declines have taken place in asbestos

exposure levels, perhaps due to OSHA efforts, but

more likely due to fears of tort liability suits.

A study commissioned for this assessment

found substantial decreases in lead levels in

workplace air and even more marked reductions

in lead levels in employees’ blood in the years since

OSHA’s new lead standard was promulgated.

Another study commissioned by OTA found substantial decreases in exposures to cotton dust following the introduction of a new agency standard. The number of workers exposed to levels

above the new, tighter exposure limit for cotton

dust has been halved in the short time since the

standard came into effect. Several textile mills appear to be in complete compliance, while others

expect to be in the near future.

Measuring OSHA’s impact is difficult. To detect

the impact of a small Federal program on something as large as the Nation’s entire work force

might be asking too much, Regarding workplacerelated illnesses, even if the data were reliable, it

is too early to expect that OSHA regulations

would have much impact on occupational disease.

On the positive side, however, OSHA standards

for vinyl chloride, cotton dust, and lead have

clearly reduced workplace exposures. Furthermore, increased productivity accompanied compliance with both the vinyl chloride and cotton

dust regulations.

Reindustrialization and Workplace

Health and Safety

Over the years, the process of industrial change

and renewal has led to improvements in occupational health and safety. Although quantitative

estimates are lacking, to some extent the reported

declines in injury rates dating from early in this

century may be due to the installation of modern, safer plants and equipment. A second factor

may be general shifts in employment away from

industries and operations with greater hazards.

Similarly, in some particular cases, exposures to

health hazards have declined because of increased

mechanization, but it is not clear whether exposures to health hazards overall have decreased,

remained the same, or increased.

Thus, through the process of industrial change

health and safety can improve without anyone’s

explicitly “intending” it. In addition, some changes

in the workplace have taken place because of

employers’ desires to minimize the threat of fire

and explosion or to reduce the downtime of plant

or equipment. Some changes that lower the threat

of property damage or “down time” also reduce

exposures to toxic agents or the risk of injury.

If this country is entering a period of reindustrialization, many opportunities will be available

to improve health and safety. As new plants are

built, employers may take advantage of opportunities to install controls as part of initial construction, when they can be put in at lowest cost.

If the Government provides economic incentives

or financial assistance to firms as they modernize, it can consider methods to encourage the installation of controls. Some of the incentives

already mentioned—including tax breaks and direct financial subsidies, as well as possibly timing new OSHA regulations to coincide with industrywide changes—might be useful during a

period of reindustrialization.
16 . Preventing Illness and Injury in the Workplace

OPTIONS FOR CONTROLLING WORKPLACE HAZARDS

Data and Hazard Identification

Increasing the Usefulness of

Current Data Systems

Identifying workplace health and safety hazards

is the first step in reducing occupational morbidity and mortality. Certain changes in Federal data

collection efforts can make epidemiologic investigations.

Mortality Surveys.--One nationwide study of

death certificates to examine associations between

industry and occupation and mortality was done

in the 1950s. Since then, epidemiologists in the

States of Washington and Rhode Island have conducted statewide studies. These are valuable not

only for identifying high risks associated with

some types of work but also for indicating occupations and industries that do not present high risks.

Yet statewide mortality analyses cannot be representative of the Nation as a whole and lack the

statistical power that would be present in an analysis of data for the whole country. Nationwide

mortality analyses would provide important leads

for further study to pin down associations between work and various causes of death, as well

as valuable information about hazards in occupations that are scattered across the country, e.g.,

carpenters or butchers.

Currently, NIOSH and the National Center for

Health Statistics provide instruction and assistance to a few States that are conducting mortality surveys. A collaborative effort between NCHS

and NIOSH would probably best accomplish the

task of carrying out nationwide mortality surveys.

Option I: Congress could provide funds and personnel for an NCHS/NIOSH collaborative effort to produce accurate coding of industry and

occupation information on death certificates.

That information could then be used to produce mortality analyses for occupations and industries either in:

s the few States that are establishing mortality surveys or

● nationally.

The National Death Index. -Information on

death certificates is essential to any epidemiologic

study investigating causes of death. When supplied with someone’s name and date of birth or

Social Security number, the National Death Index (NDI), a service of the NCHS, can tell epidemiologists whether that person has died and

where the death certificate is located. Until NDI

was established, epidemiologists had to contact

every department of vital statistics to locate the

death certificate. Quite simply, the NDI reduces

the number of such inquiries from more than so

to 1, although each certificate must still be obtained from the office of vital statistics that holds

it.

The NDI would be more useful if it supplied

all the information encoded upon death certificates. Were it to be modified to do that, epidemiologists could obtain all vital information for

mortality studies from a single inquiry. The benefits of such a change would be to speed up studies

and reduce their costs. Such a change would increase the work load at NCHS associated with the

NDI and require some system whereby State departments of vital statistics could still receive revenue for supplying information.

Option 2: The National Death Index could be

modified so that all information collected on

death certificates can be made available from it.

Addresses From Internal Revenue Service

Records.—Epidemiologic studies frequently require investigators to interview subjects of the

study or their families. One impediment to such

efforts is the difficulty of locating people. Internal Revenue Service (IRS) records are a reasonably complete source of recent addresses, but only

NIOSH and some other Federal agency scientists

and persons working on contract to NIOSH can

obtain addresses from IRS.

There is some confusion about who can use this

“NIOSH window” and clarifications about this

are needed. In addition, it may be desirable to

allow a wider spectrum of researchers to obtain

addresses from IRS. Any expansion of the win-
Ch. l—Summary and Options 17

dow would require safeguards so that addresses

received this way are used only for epidemiologic

studies.

Option 3: Congress could direct the Federal agencies to define clearly who can obtain IRS-held

addresses and create procedures to allow a

wider spectrum of researchers to obtain addresses from the IRS for use in locating persons

for epidemiologic studies.

Linking Federal Data Systems to Facilitate Epidemiologic Studies. –The records systems of the

Census Bureau, Social Security Administration,

Veterans’ Administration, OSHA, and NIOSH

could be linked together to provide information

about medical conditions, work history and exposures, and the current address in a single file.

Such a link could improve epidemiologic studies;

but it increases also the possibility of invasion of

a person’s privacy. The option suggested here is

intentionally vague because of the delicate balance between improving our capacity to understand disease and protecting citizens’ privacy.

Although epidemiologists are convinced of the

value of linking together data systems, few efforts

to do so have been approved. “On Occupational

Cancer Estimation, ” the recent report of the Department of Health and Human Services’ Committee to Coordinate Environmental and Related

Programs, suggests some options for linking data

systems.

Option 4: Congress could encourage consideration of various proposals to link together Federal data systems for use in epidemiology.

Injury Investigation

OSHA investigates 1,500 to 2,000 accidents involving fatalities or five or more hospitalizations

each year. Unfortunately, little attention has been

paid to using the collected information to prevent

future accidents, and for many years it had only

gathered dust in OSHA’s files. The agency has

conducted some limited analyses of these investigations, has initiated a small effort to distribute summaries of construction accidents to labor

unions, trade associations, and other organizations, and is developing a new data system to provide information collected during accident investigations. Complementing these activities, NIOSH

has begun detailed investigations of a small number of fatal injuries. In addition, the BLS has obtained information on some types of nonfatal

injuries through questionnaires completed by injured workers.

Option 5: Congress might direct OSHA, N1OSH,

and BLS to devote additional resources to investigating fatal and nonfatal injuries, with the

objective of developing information useful for

preventive efforts.

BLS Annual Survey

The BLS Annual Survey, which collects information from employer-maintained logs of injuries

and illnesses, is the best source of information

about occupational fatalities and nonfatal injuries.

Since 1981, employer-maintained injury records

and the results of the BLS Annual Survey have

been used to grant exemptions from OSHA inspections. Because of this reliance on the data,

assessing the reliability of the responses would be

prudent.

In the early 1970s, BLS conducted onsite evaluations of a sample of employer responses to the

Annual Survey to verify their accuracy. This

“Quality Assurance Program” has not been

repeated since 1976.

Option 6: Congress could direct OSHA and BLS

to conduct a new “Quality Assurance Program”

to determine the accuracy of employer-maintained injury records.

Toxicology

The Federal Government, especially through

the National Toxicology Program and the National Center for Toxicological Research, is supporting large-scale efforts to improve toxicology

so that results will be more predictive of human

effects and more readily accepted in the setting

of standards. The Toxic Substances Control Act

mandates the submission to EPA of information

about “substantial risks” to human health that are

identified by companies. This section of the statute and the act’s requirement that companies notify EPA of available toxicologic information

before new chemicals are introduced into commerce are important in protecting workers’ health.

This assessment suggests no particular options re-
18 . Preventing Illness and Injury in the Workplace

garding toxicology, but it draws attention to the

importance of those programs.

Improved Control Technologies

NIOSH-Supported Research on Controls

Provided with sufficient resources, NIOSH,

through vigorous grant and contract programs,

could encourage the application of the techniques

of engineering, epidemiology, ergonomics (human-factors engineering), industrial hygiene, and

other disciplines to the development of innovative

hazard control methods. Increasing NOSH’S research in control technologies even five- or tenfold need not require a proportional increase in

NIOSH staff. Most of the research could be done

in private sector and university laboratories.

Increased research and development of control

technologies would enable the Federal Government to provide new information to improve

safety and health. It might also improve cooperation between the Federal Government and occupational health and safety professionals in the private sector. Research in control technologies

represented only 12.8 percent or about $7.4 million of the NIOSH budget in fiscal year 1983.

Three general research areas could benefit from

additional funding: engineering controls, personal

protective equipment, and new production techniques.

Workplaces built some years ago with little attention to occupational health and safety often

incorporated few injury and illness controls when

they were constructed. Instead, controls—if they

are used at all—are added later as retrofits. Additional work is needed to develop general principles

for designing controls into plant and equipment

in order to increase effectiveness and minimize

interference with production. Another goal could

be improved control at reduced cost. Lower costs

might reduce employer and manufacturer resistance

to the installation of controls and the burdens of

regulatory standard setting and enforcement.

Research on personal protective equipment

should develop reliable and comfortable devices

and methods to assess efficacy in “real-world”

conditions. Research on respirators is particularly

needed, but investigations of other kinds of personal protective equipment are also important.

A third priority area for research in worker

health and safety is new technologies. The hazard potential of new processes, procedures, equip

ment, and techniques needs to be evaluated, and

attention paid to the development of controls.

Early attention to hazards will provide health benefits to workers; moreover, lower costs are associated with building hazard control into the technologies at first rather than having to retrofit later.

Option 7: Congress could expand support of

NIOSH research and demonstrations in control

technologies, using both NIOSH staff and resources as well as grants, cooperative agreements, and contracts. This expanded research

and demonstration effort could be directed at

four different areas:

● fundamental engineering research, directed

●

at finding generalizable principles for health

and safety controls;

applied research and demonstration projects

concerning improved engineering control

techniques;

research in improved personal protective

equipment;

efforts to track emerging industries and new

plants, evaluate hazards, and offer advice to

firms engaged in new technologies,

Private Sector Research

Much research, especially that oriented towards

the development of controls for particular installations, is conducted by employers, equipment manufacturers, and the insurance industry. Their efforts have produced successful solutions for many

occupational health and safety problems, To the

extent that they have the appropriate expertise,

employers and manufacturers should be eligible

for NIOSH research grants and contracts.

Certification and Regulation of

Personal Protective Equipment

All types of personal protective equipment pose

similar questions: What kinds of tests for effectiveness should be required? When should the tests

be done—before or after marketing? Who should

conduct the tests? How should test results be used?

Option 8: N1OSH could be given resources to

establish procedures to test and certify some or
—.

Ch. l—Summary and Options ● 1 9

all types of personal protective equipment; the

agency might:

Option 8A: establish a program of premarket

testing that includes, at a minimum, appropriate laboratory evaluation of personal protective equipment, and, as soon as possible,

testing and certification to reflect real workplace situations;

Option 8B: conduct postmarked surveillance to

collect reports of equipment failure and defects, and to investigate those reports; or

Option 8C: explore alternative arrangements

for both premarket testing and postmarked

surveillance of persona! protective equipment.

These arrangements could include different

combinations of self-testing and certification by

manufacturers, testing and certification by independent parties, “spot-check” testing by

NIOSH, and full-scale testing by NIOSH.

Although employers and employees rely on effectiveness labeling to select equipment, those

figures often overstate actual effectiveness. For example, OSHA instructs its compliance officers to

assume that hearing protectors provide only so

percent of the laboratory-measured protection.

Option 9: Congress could provide OSHA and

NIOSH with resources to develop, collect, and

disseminate information on “real-world” effectiveness of currently available personal protective equipment.

Education, Training, and

Information Dissemination

The Federal Government provides in-house

training to its own and other employees and grant

support for various education and training programs. One example of an in-house activity is the

OSHA Training Institute, which provides continuing education to Federal and State OSHA staff

(principally inspectors) and, to a limited extent,

to individuals from the private sector. Grant-supported activities are split: OSHA has concentrated

on employee and employer training, whereas

NIOSH has general responsibility for the education of professionals.

Workers and Supervisors

Since 1978, the OSHA New Directions Program

has awarded grants to labor unions, trade associations, universities, and nonprofit institutions

for developing and conducting training and education programs. The focus has been worker training, although a number of New Directions grantees have also trained supervisors and produced

educational materials useful to supervisors, managers, and workers.

The New Directions Program, although not so

well evaluated as it could be, is seen as a success

by many health and safety professionals. Currently the grants that were supported by transfer

of money from the National Cancer Institute to

OSHA are being evaluated, and other assessments

could be encouraged. The characteristics of good

and poor projects should be publicized and the

funding level of the New Directions Program,

which has been decreased, could be reconsidered.

Aiding local or industry-centered organizations

to find solutions to local problems provides a direct approach to health and safety problems,

Option 10: Congress might increase Federal support for occupational health and safety education and training, possibly through the New

Directions Program, by:

●

●

involving unions, workers’ organizations,

and trade and educational associations in

education and training through the provision

of grants to develop informational and

educational materials and to hire professional

health and safety staff;

supporting education of supervisors and

managers in occupational health and safety

through programs directed at providing

educational materials to employees.

The Federal Mine Safety and Health Act of 1977

requires mine operators to provide certain specified amounts of safety training to workers. Some

OSHA standards require employers to provide

worker training concerning specific hazards, but

there are no requirements for instruction or training in most occupations. However, in the absence

of any requirement, some employers provide

health and safety training. Furthermore, some col-
20 ● Preventing Illness and Injury in the Workplace

lective bargaining agreements specify that all

workers receive some training and that advanced

instruction be provided to worker members of

health and safety committees.

Option 11: Employers might be required to provide a certain minimum level of health and

safety training to their entire work force.

Health and Safety Professionals

NIOSH training grants to universities support

two activities: academic programs that train individuals in a single specialty, and Educational

Resource Centers, which provide complete programs. Many health and safety experts believe

that these funds have been well spent, increasing

the number of graduated professionals and enhancing the abilities of professionals through continuing education. On the other hand, there has

been only limited evaluation of these programs

or the actual impact that the increased number

of professionals has had on worker health and

safety.

Funding for these programs has been reduced

in recent years and the current administration has

proposed complete elimination of the ERCs. Cutbacks in Federal funding in this area are likely to

reduce the number of trained professionals.

Option 12: Congress could continue to fund training of occupational health and safety specialists,

including the Educational Resource Centers,

through the NIOSH training grants program.

Engineers, Physicians, and Managers

The disciplines of engineering and medicine

have a marked impact on occupational health and

safety even though most practitioners in these

disciplines are not specialists in workplace health

and safety. Neither general-practice physicians

nor engineers receive significant instruction about

occupational hazards and controls. For physicians, the prime need is training to recognize the

impact of occupational exposures on health. Engineers need to understand the nature of occupational hazards and to learn the fundamental design

techniques useful for prevention of work-related

illness and injury. In addition, managers play an

important continuing role in decisionmaking

about health and safety.

Some starts have been made (and some abandoned) to extend information about safety and

health to physicians, engineers, and business

administration educators and students. The Department of Health and Human Services supported some efforts to educate physicians in environmental and occupational health in several

medical schools in the late 1970s, but funds are

no longer available. NIOSH has sponsored a series

of workshops on the topic of engineering education concerning health and safety,

Option 13: Congress could provide support for

and encourage:

●

●

●

introducing occupational medicine in medical school course work;

introducing or expanding occupational safety

and health into engineering school curricula;

introducing or expanding classes about occupational health and safety in business

administration courses,

For example, grants through NIOSH or the National Science Foundation might be used to develop training modules for integration into existing courses.

Expanded Information Services

The OSHA consultation program, which was

instituted to provide health and safety evaluations

to businesses, especially small firms, is a relatively

popular program. One possibility is to expand the

program to provide consultation to a greater number of employers as well as to employees and

unions. This would require funding, as well as the

creation of procedures for providing these services.

Option 14: Congress could expand the OSHA

consultation program by:

●

●

●

providing increased funding for OSHA consultation;

directing OSHA to explore methods to encourage employers to share this information

with employees and their representatives;

expanding the consultation program to provide this service to employees and unions.

Insurance Industry Research

Representatives of insurance companies visit

more plants than OSHA is able to inspect, and

many employers, especially small firms that lack
.— .

full-time health and safety personnel, rely on the

advice of their insurers’ loss-control specialists.

The establishment of an institute similar to the

Insurance Institute for Highway Safety might facilitate the dissemination of industry-collected information on occupational health and safety. No

option is proposed because there would be no Federal role in such an institute,

Computerized Information Systems

There are many useful collections of data. For

instance, NIOSH produces and collects information about toxicity, assessment of control technologies, and product testing; OSHA collects information about hazards and controls during

inspections, consultations, and courses. Combining information from some or all of these sources

would produce a data system for use by designers,

engineers, workers, employers, and health and

safety specialists. Users could be charged for services to defray expenses and possibly to make the

service self-supporting.

Option 15: The Federal Government could provide grant or contract money to apply computer technology to the collection and dissemination of occupational health and safety

information.

Incentives and Imperatives

Voluntary Implementation of Controls

Voluntary employer efforts to improve health

and safety are very important. OSHA has initiated a program to encourage such efforts, and

NIOSH has often persuaded employers to control hazards that are not currently subject to

OSHA regulations. Attempts to encourage “voluntary protection” must be kept in balance, however, with the standard-setting and enforcement

required by the OSH Act.

Option 16: Congress could direct OSHA and

NIOSH to increase the attention devoted to encouraging voluntary efforts and to publicize the

firms that have exemplary programs in health

and safety,

Ch. l—Summary and Options ● 2 1

—

Workers’ Compensation Programs and

Tort Liability

Workers’ compensation programs, administered by the States, have been credited with contributing to the prevention of injuries and illnesses.

There is reason to believe that this may be true

for occupational injuries, although data to support this conclusion are limited. For illnesses, data

are even more sparse, and the programs offer

fewer incentives for prevention of illness than for

injuries.

Most potential lawsuits by employees against

their employers for occupational injuries and illnesses are barred by the statutes that created the

State workers’ compensation systems. It has been

suggested that this prohibition be eliminated in

some circumstances, but this would involve major changes in workers’ compensation laws.

Congress is considering legislation to provide

compensation for the victims of asbestos-related

disease. This proposal is a response to perceived

problems in both the workers’ compensation and

tort liability systems.

Prevention should be considered in any changes

in compensation. In general, a compensation system should be designed to encourage prevention.

If Federal revenues are used to supplement occupational disease compensation funds, the Federal contribution might be accompanied by a requirement that companies take concrete steps to

prevent future cases of disease—a suggestion that

is admittedly hard to implement, Since OSHA

would almost certainly already be regulating any

hazard important enough to require a Federal contribution to compensation, it is not clear what additional requirements might be imposed on companies that benefit from compensation legislation.

But it is also important to consider carefully any

changes in either compensation or tort liability

to guard against changes that might weaken incentives for prevention.

Labor-Management Committees

Labor-management health and safety committees exist in many U.S. workplaces, in both union
22 ● Preventing Illness and Injury in the Workplace

and nonunion shops. They offer an avenue for

sharing and conveying information about hazards

and controls. OSHA currently supports the formation of joint committees in companies that

participate in the OSHA Voluntary Protection

Programs.

Option 17: Congress could encourage the formation of labor-management committees by:

●

●

directing that OSHA expand its Voluntary

Protection Program;

increasing OSHA funding for training, consultation, and other technical assistance to

workplaces with labor-management committees.

The Role of OSHA

Updating OSHA Regulations

It is well known that OSHA lags behind professional health and safety organizations and consensus standards in responding to new information about health hazards. The agency upgrades

its regulations through the same time-consuming

rulemaking procedure it uses to promulgate new

regulations, and changes are often opposed.

OSHA considers NIOSH recommendations

about exposure limits, but has taken few regulatory actions based on NIOSH criteria documents.

Requiring an OSHA response to NIOSH recommendations would ensure that the regulatory

agency considered the research agency’s findings,

but making it mandatory for OSHA to regulate

on the basis of NIOSH recommendations might

not be useful. The Mine Safety and Health Administration (MSHA) is currently required to respond to certain NIOSH recommendations. However, NIOSH has sent no such recommendations

to MSHA, perhaps because of the direct tie between recommendation and regulation.

Option 18: Congress might direct OSHA to develop methods to respond to changes in national consensus standards and other professional recommendations.

Option 19: Congress might require OSHA to consider NIOSH recommendations for new or

more stringent controls within a fixed period

of time—say, 2 or 3 years. At the end of that

time, OSHA could adopt, modify, or decide

against adopting the recommendations, but it

would have to respond or be subject to suit.

Without changing the current system of standard setting, OSHA inspectors could provide information to both employers and workers concerning professional recommendations. Although

it would not be legally binding, employers might

take actions based on this information.

Option 20: OSHA inspectors could be directed

to provide information (to employers and employees) on current NIOSH recommendations,

professional organizations’ recommended exposure limits (such as ACGIH’s, which are updated annually), and voluntary standards

whenever these recommendations and standards would affect the hazards found in particular workplaces,

Standard Setting

Despite the fact that it did not succeed, a recent effort to negotiate a standard for benzene

should provide much valuable information about

the feasibility of using negotiations in standard

setting.

Option 21: Congress might encourage OSHA to

study possible procedures for negotiation during standards development and implementation. These procedures will have to assure the

adequate representation of all affected parties.

In the setting of health standards, OSHA has

generally moved substance-by-substance, Each

proposed health standard can be, and most have

been, opposed. OSHA has made three attempts

to establish “generic standards. ” The agency promulgated a “cancer policy” in 1980 that defined

what data would be necessary and sufficient to

make a decision about a substance being a carcinogen and the nature of the standard that would

then be issued. The “access to records regulation, ”

a generic standard applying to all employer-held

health and safety records, guaranteed workers the

right to inspect records and required that employers retain them. The recently promulgated labeling, or “hazard communication” standard also has

generic aspects.

Generic standards offer greater efficiency in that

matters of a general nature can be settled once
Ch. l—Summary and Options ● 2 3

rather than being renewed for every specific case.

There are, however, difficulties in issuing broad

regulations that are to apply in many situations.

Moreover, there is no guarantee that generic

standards will be used. For example, no carcinogens have been regulated under the agency’s “cancer policy. ”

Possible areas for generic standards include exposure monitoring and employee training. It may

also be possible to issue standards that deal with

groups of, rather than single, substances.

Option 22: OSHA could be encouraged to issue

generic standards to supplement substance or

hazard-specific rules.

OSHA Enforcement Activity

No other OSHA activity stirs up so much emotional fervor as its inspection and enforcement

activities. Many businesses object to inspections

as being nit-picking and unrelated to employee

health and safety, Employees and unions, on the

other hand, believe that inspections are essential

to worker protection and are concerned that

OSHA devotes insufficient resources to them and

that inspectors are not vigorous enough in enforcing legal requirements.

Whatever the number of inspections, some violations are found and punished by fines, In most

cases, the fines levied by OSHA are less than the

costs of controlling hazards. One possibility

would be to increase fines to levels equal to the

actual costs of implementing controls. Or fines

might be based on a calculation of the amount

necessary to have a deterrent effect.

In some cases, fines equal to the costs of control would exceed the maximum levels established

in the OSH Act. Therefore, the law may have to

be changed to allow higher penalties. Of course,

higher penalties will raise the number of contested

OSHA actions and the general level of controversy in this field.

Option 23: Congress could consider what the

appropriate level of OSHA enforcement activity should be; it could then either:

● continue the current levels of personnel and

funding for inspection activity and the new

policies concerning inspection targeting and

citation settlement; or

● increase the number of inspectors, and the

level of fines, and change the targeting and

settlement policies to increase incentives for

compliance.

Other Federal Actions Affecting Hazard Control

Various tax and financial assistance programs—

investment tax credits, accelerated depreciation,

government loan programs, and direct subsidies—might encourage employers to install control

technologies. However, all these programs have

disadvantages. First, they would reduce Federal

tax revenues or increase budget outlays. Second,

depending on their design, tax-based incentives

can be relatively inefficient mechanisms because

firms that would have installed controls, even in

the absence of the program, would now receive

a tax subsidy, Third, there will be difficulties in

dividing the purchase price of equipment between

features that are health and safety controls and

those that are part of the equipment for purely

productive reasons.

Option 24: Congress might enact a tax and financial assistance program to assist businesses in

improving occupational safety and health.

As the United States considers its economic and

industrial policies, it is unclear what balance is

to be struck between updating old-line industries

and focusing on new industries. In the future, the

Federal Government may play an active role in

the “reindustrialization” or “deindustrialization”

of America.

If explicit Federal

include discussions

ested businesses,

others, as well as

policies are created, they may

and agreements among interunions, communities, and

Federal loans and financial

assistance. Information could be developed concerning the health, safety, investment, and productivity needs of various industries. One possibility would be to provide financial assistance for

health and safety, as well as for productivity investments.

The general disadvantages of these approaches

include the concern that health and safety will

“take second place” to the push for productivity.

In addition, many object to any Federal role in

coordinating or financing industrial investments.
24 ● Preventing Illness and Injury in the Workplace

Option 25: If the United States makes available

funds or tax incentives for the building or rebuilding of industry:

●

●

It

controls for health and safety hazards could

be eligible for the same funds or tax breaks

as other construction costs;

companies receiving reindustrialization assistance might be required to design health

and safety into their new plant and equipment,

either to meet existing standards or to achieve

lower exposure levels or safer processes.

has been suggested that regulatory requirements have diverted resources from “productive”

uses and contributed to economic slowdowns.

However, in at least two cases (standards concerning vinyl chloride and cotton dust), new production processes were developed that both benefited

worker health and improved productivity. Fitting

regulatory activities to productivity concerns can

be achieved in two ways: either delaying regulatory requirements until they coincide with planned

modernization or using health and safety regulations to “spur” productivity improvements.

Option 26: Congress could direct OSHA to:

● delay the required use of engineering controls, so that the installation of these controls

coincides with modernization of an industry;

● use health and safety regulations to encourage plant and equipment modernization.

Creation of an Occupational Safety and

Health Fund

OTA is aware of concern about recent large

swings in occupational safety and health policy.

Two areas—education and training programs,

and research on workplace controls—have had

funding reduced in the past few years. The creation of an Occupational Safety and Health Fund

might provide more stable and enhanced funding.

Recent U.S. research concerning the use of

“washed cotton” to control the hazards of cotton

dust also provides a model for cooperative research. This project was funded by Government

and industry, with oversight and direction provided by a group of labor, management, and

Government officials. Jointly administered research efforts and training programs have also

emerged from collective bargaining.

A fund could be established with or without

a Government contribution. For example, interested citizens, employers, workers, foundations,

and other groups could make voluntary contributions. Or Congress could create a fund. If it

becomes a Federal activity, financing could be

through a payroll tax on employers or, although

this would be more difficult, through a tax or surcharge based on workers’ compensation premiums

(with some adjustments for the presence of health

hazards in various industries). For example, a 0.1

percent employer tax on the total U.S. payroll of

$1.6 trillion (in 1982) would result in annual

revenues of about $1.6 billion; a 0.01 percent tax

would produce $160 million. A 1.0 percent surcharge on workers’ compensation premiums

(about $25 billion in 1980) would produce annual

revenues of $250 million. Another possibility

would be to allocate fines collected for violations

of OSHA standards to this fund. This would produce less money; in 1983, OH-IA’S proposed fines

totaled $6.4 million.

Several different administrative arrangements

for such a fund are available, Congress could follow the model of the Work Environment Fund of

Sweden by creating a tripartite board of employers, employees, and Government representatives,

or it could delegate administrative responsibilities

to NIOSH, since this would be a research and information dissemination activity. The fund and

its research and training projects could exist

alongside existing projects and arrangements at

OSHA and NIOSH, or Congress could consolidate existing research and training activities (including NIOSH extramural research grants and

training grants, OSHA New Directions grants and

OSHA-funded consultations) under one umbrella

group.

Although such a fund would enhance the commitment to research and training, there are disadvantages to consider—primarily that this represents a new venture, with all the problems that

such undertakings incur. Moreover, a new tax or

surcharge, even though of modest size, runs against

the desire embodied in recent legislation to reduce

business taxes.
Ch. l—Summary and Options

—

● 2 5

Option 27: Congress could create an Occupational

Safety and Health Fund to finance research in

control technology, training and education, and

information dissemination.

The Needs of Small Businesses

Loans for Compliance With OSHA Standards

Small businesses are often disproportionately

burdened by investments required for health and

safety protection. Congress recognized this when

it passed the OSH Act by also amending the Small

Business Act to allow the Small Business Administration (SBA) to make loans for OSHA compliance. Between 1971 and 1981, when Congress

eliminated authorization for this program, SBA

processed 261 such loans. Now may be a good

time to study this program to learn what effect

these loans had and why so few were processed.

Following such a study, Congress could consider

reauthorizing the loan program.

Option 28: Congress might direct OSHA and/or

SBA to study the results of SBA loans made

for compliance with OSHA standards.

Shared Resources

It is inefficient and impractical to require each

small business to provide a full range of health

and safety services. Instead, organizations and

programs to serve the needs of a number of small

businesses in a given area or industrial specialty

might be cost effective. Initial funding could come

from OSHA or NIOSH, with the hope that these

programs would ultimately be self-supporting.

The most difficult part of this option is to design a method to sustain the program after the

startup period. Even though shared programs

should cost less than if a company were to purchase the services entirely on its own, some small

businesses might find the price beyond their

means. It is unclear how to aid those companies.

Option 29: Congress might direct NIOSH and

OSHA to encourage the development of shared

programs to provide industrial hygiene, safety

engineering, medical surveillance, and worker

health and safety training for small businesses,

Changed Regulatory Approaches

Providing protection against occupational injuries and illnesses in small business establishments

presents its own set of problems. It may be cost

effective to treat occupational health and safety

in such firms in a fashion similar to current regulation of consumer products—by regulating machines and products that small businesses

purchase.

Of course, many products purchased by small

businesses are also used in larger businesses,

whose employees would also benefit from such

regulation. An important limitation of this approach is that some occupational hazards are created in the improper installation, use, and maintenance of machines and products. This

regulatory approach would have only limited impact on those hazards.

Option 30: Congress could take actions to improve the safety of products used by small business. This might include:

• directing NIOSH to conduct tests of products used by small businesses and to publish

the results in a form easily available to such

establishments;

● encouraging OSHA, Consumer Product

Safety Commission, and EPA regulatory actions concerning the products used by small

businesses.

Establishment of Occupational Medicine Clinics

In the United States, most occupational medicine is practiced in the workplace by physicians

employed by industry, especially by large companies.

Changes are apparent, however, as small-and

medium-sized companies are making choices between contracting with hospital-based clinics for

medical care or maintaining a company medical

department. The clinics may grow to fill current

voids—servicing industries, regions, and employers where such services are unavailable or deficient. Clinics might, because of a larger patient

load and a staff that consequently sees more patients, be able to provide more-knowledgeable

care and improved physician training.
26 . preventing Illness and Injury in the Workplace

The staff of these clinics emphasize that they

will provide advice about prevention as well as

medical care. The combination of staff physicians,

industrial hygienists, and engineers could provide

a critical mass for a great deal of important activity in hazard identification and control.

Programs concerned with occupational medicine and prevention should consider and study the

choices. They may alter industrial medical care

and responsibilities of industry and labor, as well

as the relationships between such clinics and the

private practice of medicine.

Assessing Health and Safety Programs

A key final component in improving occupational health and safety is evaluating which programs to identify hazards, develop control technologies, disseminate information, and implement

controls work and which programs can be improved. Assessing or evaluating efforts in occupational safety is difficult because of the many factors that influence injury rates over time. Some

of these may also stymie the evaluation of occupational health activities; more importantly, because

of latent periods and difficulties in recognition,

it is hard to measure improvements in occupational health.

Congress in the last few years has already indicated a desire for more systematic assessment

of Government activities. The Regulatory Flexibility Act of 1980, for example, requires that regulatory agencies, including OSHA, review over

a 10-year period all regulations that have a significant impact on small businesses.

This principle of reviewing and analyzing existing programs might be extended to nonregulatory programs. For example, the OSHA New

Directions grants program, and the NIOSH training grants programs could be assessed. In addition, periodic assessment could be specified when

new programs are established. The principal disadvantage of such a requirement would be the

diversion of resources from other important areas,

such as hazard identification and research on control techniques.

Option 31: Congress could require periodic assessment of all occupational safety and health programs and provide funds to conduct such

assessments.
2.

Data on Occupational

Injuries and Illnesses
Contents

—
2

Data on Occupation;

Injuries and Illnesses

In this chapter, OTA presents a summary of ber of occupational injuries in U.S. workplaces.

the available statistical information concerning the For occupational illnesses, however, the data are

number and distribution of occupational injuries extremely limited. (A fuller discussion of these

and illnesses. In general, currently available data topics is found in Working Paper #l of this

describe, with reasonable accuracy, the total num- report. )

SOURCES OF INFORMATION

Prior to the passage of the Occupational Safety

and Health (OSH) Act in 1970, occupational injury data collection efforts were limited. One

source was a series of surveys by the Bureau of

Labor Statistics (BLS). This information was

limited by its dependence on voluntary reports

from employers, by the particular standard most

commonly used for recording occupational injuries, and by incomplete industry coverage by

the BLS surveys. One study of data from 1967

and 1968 indicated substantial underreporting of

injuries by employers (186), In addition, some

limited data were available from the National

Safety Council (NSC), state workers’ compensation agencies, and employer records. In the OSH

Act, Congress called for the creation of a new,

mandatory system of data collection.

The system created by the Occupational Safety

and Health Administration (OSHA) and BLS requires employees to keep records using a specified format. In addition, BLS conducts annual surveys of a sample of employers. These survey

results are used to compute injury and, to a

limited extent, illness rates by industry, as well

as estimates of the total numbers of fatalities, lostworkday cases, and cases without lost worktime

but that involved medical treatment.

The BLS Annual Surveys (604,606-608) are the

best source of statistical information concerning

work-related injuries. The published data are

based on large survey samples, and, within the

limitations of the survey methods, appear to be

reliable. These estimates, however, are subject to

several limitations:

● they are available only since 1972,

● depending on the type of case, they cover

only two-thirds to three-fourths of the U.S.

work force,

● they are based on a survey that is administered only once a year, and

● they provide very little detail concerning the

nature and causes of occupational injuries.

A possible fifth limitation is that these estimates

are ultimately based on employer records of injuries and illnesses. (The extent of this possible

bias is discussed below and in Working Paper #l. )

Nothing can now be done about the first limitation. The second and third could be improved,

but these would involve changes in methods and

perhaps require greater resources. To address the

fourth limitation, BLS has initiated two additional

data collection efforts. Since 1976, the Bureau has

compiled information provided by 26 to 36 state

workers’ compensation agencies, in a data base

known as the Supplementary Data System (SDS)

(397). And since 1978, BLS has conducted a series

of surveys of injured workers concerning specific

types of occupational injuries, published as Work

Injur y Reports (599-601,603,605).

Two other Federal systems provide injury data.

The National Health Interview Survey (NHIS) of

29
30 ● Preventing Illness and Injury in the Workplace

the National Center for Health Statistics (NCHS) cy room admissions to produce information on

collects information during household interviews. occupational injuries. Finally, OSHA has pubA system recently developed by the National lished analyses of several different types of fatal

Institute for Occupational Safety and Health injuries using information collected during acci-

(NIOSH) uses information from hospital emergen- dent investigations.

OCCUPATIONAL INJURIES

Fatal Injuries

As discussed in Working Paper #l, for the last

five years, data from the BLS Annual Surveys indicate that between 3,000 and 5,000 occupational

fatalities occurred each year in private sector

establishments with 11 or more employees. About

1,000 deaths occur in private sector establishments

with fewer than 11 employees. The NSC figures

range between 11,000 and 13,500 for the entire

workforce. Applying a variety of assumptions to

data derived from death certificates yields a range

of estimates from 5,500 to 11,000 for the entire

workforce for 1977. OSHA inspection data suggest that at least 4,500 occupational fatalities

occurred in the private sector workforce in fiscal

year 1982.

The Annual Surveys conducted by BLS are the

best source of statistical information on occupational injuries. They use a large survey sample that

is capable of directly measuring the occurrence

of injuries. However, because this sample covers

only private sector employment (the self-employed and public sector employees are excluded),

an adjustment must be made to generate an estimate for the entire workforce.

OTA used two similar methods, both based on

the BLS data, to develop its estimate of the number of occupational fatalities due to injuries. The

first estimate uses the five-year average of the

number of fatalities in establishments with 11 or

more employees. For 1979 to 1983, this equals

about 4,180. Approximately 11 percent of these

are due to heart attacks. Subtracting these yields

a total of 3,720 deaths due to injury (see table 2-

1). To this should be added the five-year average

from the BLS Annual Survey of deaths in establishments with fewer than 11 employees. For 1979

to 1983, after adjusting for heart attacks, this was

930. Thus, the total from the BLS Annual Survey is 4,650.

To this should be added the deaths among the

self-employed and public employees. Applying

the death rates for private sector workers, adjusted for heart attacks, to these workers yields

a five-year average of 1,640. Adding this to the

4,650 generated directly by the Annual Survey

yields a total of about 6,300 deaths.

Table 2-1.—Annual Occupational Fatalities From Injuries,

Summary of Estimates

Average

annual Source of

Universe Years total estimate or data

All employment . . . . . . . . . . . . . . . . . . . . . . . . . . 1979-83 12,200 NSC

All employment . . . . . . . . . . . . . . . . . . . . . . . . . . 1979-83 6,000 OTAa

Private sector workplaces

with 11 + employees . . . . . . . . . . . . . . . . . . . . 1979-83 3,720 BLS

Private sector workplaces

with 1-10 employees . . . . . . . . . . . . . . . . . . . . 1979-83 930C BLS

aEgtlmate ig b~~ cm BLS arid OSHA data and Is described in the text

bd,l~ minus I I percent of deaths reported es heart attacks (~).

c1 ,040 minus 11 percent of deaths reported as heari attacks. (110

NOTE: Because of differing methods and deflnltions, some of these estimates are, strictly speaking, not directly comparable

with each other.

SOURCE: Office of Technology Assessment.
——— —. . .

Ch. 2—Data on Occupational Injuries and Illnesses ● 3 1

Alternatively, the BLS figures for establishments with 11 or more employees for each individual year can be adjusted by applying the

private-sector death rate (for injuries in establishments with 11 or more employees) to the workers excluded completely (self-employed and public

employees) or for which annual estimates are not

available (small, private sector establishments).

Using this method, the total ranges from 7,265

in 1979 to 4,600 in 1983, with an average of 6,180

deaths per year.

Rounding either of these estimates to the nearest

thousand yields OTA’s estimate that about 6,000

deaths due to occupational injuries occur each

year. The National Safety Council average of

12,200 is considerably higher. It is difficult if not

impossible, to reconcile the estimates from the BLS

and the NSC. The published data from state vital

statistics are insufficient to do so (see Working

Paper #l). Moreover, the NSC estimates have

been criticized in the past for including duplicate

reports and deaths from previous years and for

not being based on the results of a probability survey. Instead they are developed using the results

of special studies in combination with a variety

of statistics from several sources. These methods

may not generate reliable estimates, either for a

particular year or over time.

OTA’s estimate of 6,000 injury deaths per year

translates into about 25 occupation] fatalities

each working day. Rarely, however, does this

daily toll occur at the same time, in the same

workplace. Usually, occupational deaths occur

one or two at a time in widely scattered workplaces. Because of this, occupational fatalities only

rarely receive significant publicity.

Motor vehicles (30 to 40 percent), off-the-road

industrial vehicles (10 percent), and falls (10 percent) are associated with over half of the fatal occupational injuries. In addition, occupational fatalities are unevenly spread among industries.

Table 2-2 presents fatality rates for the major industry divisions in the private sector. Mining,

with a fatality rate of 44.3 per 100,000 full-time

workers, is the most hazardous industry. Construction; agriculture, forestry, and fishing; and

the transportation and public utility industries also

present above-average risks of deaths due to inTable 2.2.—Occupational Fatality Ratesa

By Industry for 1982

Industry division Rateb

Mining . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44.3

Construction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28.7

Agriculture, forestry, and fishing . . . . . . . . . . . 28.4

Transportation and public utilities . . . . . . . . . . 21.9

Average of private sector ., . . . . . . . . . . . . . . . . 7.4

Manufacturing . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.5

Wholesale and retail trade . . . . . . . . . . . . . . . . . 3.8

Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.5

Finance, insurance, and real estate . . . . . . . . . 2.5

aF~r ~~t~bllghrnentg with I 1 or more employees Includes fatal injuries and

reported deaths due to illness.

bFatalit~eg per 100,000 full-time workers

SOURCE: (608)

jury. Manufacturing has a death rate below the

average for the private sector, although it has a

nonfatal injury rate substantially above the average. Wholesale and retail trade; services; and finance, insurance, and real estate are safer industries, with fatality rates between 2.5 and 3.8

deaths per 100,000 workers.

Nonfatal Injuries

Table 2-3 summarizes the estimates of the numbers of occupational injuries. These estimates vary

partly because of differences in the definitions of

injuries, the population universes, and methods

of estimation.

NSC defines a disabling injury as one that involves one or more days away from work, some

form of permanent impairment, or death. For BLS

and OSHA, a lost-workday injury is one that involves the employee either not working at all for

one or more days beyond the day of the injury

or reporting to work and being assigned to a

“lighter duty” job (restricted work activity).

Combining the BLS estimate of lost-workday

injuries (2.1 million in both 1982 and 1983) in the

private sector with the estimates for Federal, State,

and local employees (0.1 and 0.3 million) yields

a total of 2.5 million lost-workday injuries. This

compares to the NSC estimate of 1.9 million “disabling” injuries. Using the total of 2.5 million injuries, it appears that each working day results

in about 10,000 injuries that are serious enough

to lead to loss of worktime.
32 ● Preventing Illness and Injury in the Workplace

Table 2-3.—Annual Nonfatal Occupational Injuries,

Summary of Estimates

Source of

Estimate estimate

Definition Universe Year (millions) or data

Lost-workday cases . . . . . . . . . . . . . . . . . . . .All private sector workplaces 1983 2.1 BLS

Lost-workday cases . . . . . . . . . . . . . . . . . . . . U.S. Government—civilian and personnel 1982 0.1 OSHA

Lost-workday cases . . . . . . . . . . . . . . . . . . . .State and local government 1982 0.3 SDSa

“Disabling” . . . . . . . . . . . . . . . . . . . . . . . . . . .All employment 1983 1.9 NSC

Total “recordable” . . . . . . . . . . . . . . . . . . . . . All private sector workplaces 1983 4.7 BLS

Total “recordable” . . . . . . . . . . . . . . . . . . . . . U.S. Government—civilian and personnel 1982 0.2 OSHA

Total “recordable” . . . . . . . . . . . . . . . . . . . . . State and local government 1982 0.7 SDSa

Medically attended or activity restricted . .All employment 1981 11.3 NHIS

Treated in emergency rooms . . . . . . . . . . . .All employment 1982 3.2 NIOSH

%tlmato Is baeed on data from SDS and Annual Survey and Is described In Working Paper #1.

NOTE: Because of differing methods and deflnltlons, some of these estimates are, strictly speaking, not directly comparable with each other

SOURCE’ Office of Technology Assessment

The BLS/OSHA definition of “recordable” injury includes all lost-workday injuries plus all

those that involve medical treatment beyond first

aid. The National Health Interview Survey includes all injuries that are “medically attended”

(which may involve only a consultation with a

doctor) or cause “restricted activity,” whether or

not that also involves lost worktime. Data developed by NIOSH through the National Electronic

Injury Surveillance System (NEISS) include all

cases treated in hospital emergency rooms.

These various sources again yield differing estimates. The sum of BLS data and the Federal,

State, and local government estimates is 5.7 million recordable cases in 1982. The number of private sector injuries went down slightly in 1983,

Assuming that the number of public sector injuries

stayed the same (0.9 million), the sum of the BLS

and public sector estimates would be 5.6 million

in 1983. The NHIS estimates 11.3 million cases.

This translates into a range of between 22,000 and

45,000 injuries each working day. And the NIOSH

estimate of the number of emergency room cases,

based on the NIESS data, is 3.2 million cases or

about 12,000 cases per day.

The largest difference in these figures is between

the combined BLS and public sector estimate (5.6

million cases) and the National Health Interview

Survey (11.3 million). Most of this difference remains even when data from the same year are

used. The 1981 BLS and public sector estimate is

a total of about 6 million cases.

The NHIS includes self-employed persons, but

it is unlikely that approximately 8.7 million selfemployed workers can account for the remaining 5.3 million injuries. It could be that the slightly

different definitions of the BLS Annual Survey

and the NHIS contribute to this discrepancy. It

is also possible that employees and their families

are reporting to the NHIS injuries that are not

recorded by employers. A number of reasons

could account for employers not recording an injury: an employee may not have reported it to

the employer; the employer judged the injury to

be a “’first aid only” case that is not required to

be recorded; or the employer’s records are not accurate and comprehensive.

The NEISS estimate of emergency room cases

could be consistent with either the BLS estimate

or the NHIS figure. The 3.2 million emergency

room cases (in 1982) would constitute about 55

percent of the 5.7 million cases in the private and

public sectors from (the 1982) BLS and government reports or about 30 percent of the 11.3 million cases estimated by the NHIS. The figure of

30 percent is roughly consistent with a special

study of data from 1975, which estimated that

about 36 percent of all injuries occurring “at job

or business” were medically attended at emergency rooms (388).

Table 2-4 summarizes various estimates of the

amount of time lost due to nonfatal occupational

injuries, including lost worktime, bed disability,

and restrictions on daily activity. The BLS esti-
Ch. 2—Data on Occupational Injuries and Illnesses ● 3 3

Table 2-4.—Days Lost Annually From Occupational Injuries,

Summary of Estimates

Source of

Estimate estimate

Definition Universe Year (millions) or data

Lost workdays. . . . . . . . . . . . . . . . . . . .All private sector workplaces 1983 36.4 BLS

Lost workdays. . . . . . . . . . . . . ... . . . . U.S. Government—civilian and personnel 1982 1,2 OSHA

Lost workdays. ., . . . . . . . . . . . . . . . . . . . . . . All employment 1981 60-70’ OTA

Bed disability days. . . . . . . . . ... . . . . . All employment 1981 44.0 NHIS

Restricted activity days . . . . . . . . . . . . . . . All employment 1981 214.9 NHIS

%TA estimate IS based on data-f~om NHIS and Is–described I; Workln9-Paper #l - - – -

.

NOTE Because of dlfferlng methods and deflnltlons, some of these estimates are, strictly speaking, not directly comparable w!th each other

SOURCE Off Ice of Technology Assessment

mate of days away from work and of restricted

work activity (“light duty”) equals 36.4 million

days—the equivalent of over 140,000 people

working full-time for a year. Time lost by Federal civilian employees adds about 1.2 million

days to this total. No estimates for State and local

employees or for the self-employed are directly

available.

A higher total of about 60-70 million “’lost

workdays” can be indirectly estimated using the

results of a special NCHS analysis of injuries. Part

of the reason for the higher figure is that this estimate should cover the entire work force. In

addition, the varying definitions and survey methods between the BLS and the NHIS may contribute to the difference. The NHIS also provides data

on bed disability (44 million days) and of days

of restricted daily activity (close to 215 million

days).

The BLS figures imply that about 1 in 13 U.S.

workers suffered an occupational injury in 1982.

Nearly half of these were serious enough to result in the employee missing one or more days

of work beyond the day of the injury, On average each lost-workday injury results in 17 days

lost from work. The NSC has estimated that the

direct and indirect costs of work injuries totaled

$30.2 billion in 1980 (324),

Trends in Injury Rates

It is probable that occupational injury rates

have fallen since the turn of this century. The data

published by the NSC support this, but these data

may not be accurate or reliable. In particular, recent trends in the NSC data are inconsistent with

data collected from other sources. However, accounts of working conditions earlier in this century reveal many instances of job hazards that are

considered appalling by today’s standards. Many

of these have been improved, and injury rates

have fallen. (Of course, this decline in injury rates

may not apply to occupational illness rates. )

Trends over the last two decades have not been

constant from year to year and measures of different types of injuries sometimes go in different

directions. During the 1960s, the BLS surveys of

manufacturing showed rising injury rates. The

BLS Annual Surveys from the 1970s show a relatively large drop in non-lost-workday injuries

from 1972 to 1975, and then a continuing decline

from 1975 to 1983. The BLS lost-workday case

rate rose during most of the 1970s, falling only

between 1974 and 1975 and for the three years

after 1979 (fig. 2-1). The BLS total case rate, which

combines the non-lost-workday and lost-workday

cases, shows a slight rise from 1972 to 1973, and

then a decline from 1973 to 1975. This rate then

began a slight rising trend until its peak in 1979.

By 1982, the total case rate had declined to 7.7

per 100 workers. This decline continued in 1983,

when the total case rate was 7.6 per 100 workers. This is the lowest level reported since 1972,

when these data were first collected. Fatality rates

calculated from the BLS estimates show a general

decline through the 1970s. Injury rates calculated

from the National Health Interview Study show

no readily apparent trend from 1962 to 1981, possibly because of the relatively larger sampling

error for this survey.

Injury and fatality rates are affected by a number of factors. These include the effects of the busi-
34 Preventing Illness and Injury in the Workplace

Figure 2.1.- Occupational Injury Rates, 1972.83

21- Lost-workday cases

I

1972 1974 1976 1978

Year

ness cycle, various changes in

of workers’ compensation, the

1980 1983

the administration

practice of occupational medicine, ‘and other socioeconomic factors.

In addition, OSHA and NIOSH and other safety

and health programs may have contributed to

changes in rates. But the effects of OSHA activities, in particular, may be difficult to discern in

national injury trends because of the low probabilities of OSHA inspections, the relatively low

penalties for violations of standards, and the possibility of differential effects on various types of

hazards. There may also be variations in the effectiveness among the 24 separate State programs

and Federal OSHA operations, which cannot be

detected using national data.

Injury Rate Trends, the Business Cycle, and

OSHA Policies

The lack of any dramatic improvements in injury rates during the 1970s has been cited to support the belief that OSHA has been ineffective.

More recently, it has been claimed that the recent

declines in the injury rates resulted from the current administration’s “cooperative, non-adversary

approach to job safety and health” (643,644,650).

Although it is possible that some of the decline

can be explained by these changes, several other

features must also be considered.

First, as figure 2-1 shows, the decline in injury

rates started in 1980—before the changes in

OSHA policies that were instituted in 1981. Moreover, the installation of controls, changes in employee training, etc., often take place over several years. Thus it is possible that the observed

changes from 1979 to 1983 represent the effects

of some combination of the policies of the “old”

and the “’new” OSHA. Second, the new policy

that targets inspections on the basis of injury

records may influence employer recordkeeping

toward undercounting. Independent verification

of employer injury records is necessary to assess

the possible impact on changes in employer recordkeeping. Third, as mentioned above, a number of factors besides the effectiveness of OSHA

can influence injury-rate trends.

Foremost among the factors influencing injury

statistics is the business cycle. Since the 1930s researchers have noted that, other things being

equal, increased business activity leads to higher

injury rates while decreased activity lowers rates.

The general explanation for this phenomenon is

that as business picks up, employers hire more

young and inexperienced workers. Both younger

workers and inexperienced workers of all ages

tend to have higher injury rates than older, more

experienced workers. Moreover, as production expands, businesses open new plants and bring new

machinery on-line. For both of these cases there

may be a period of adjustment as management

and workers learn how to use the machinery safely. In addition, during a business upturn there will

be increases in the pace of production, increases

in the amount of overtime worked, less down

time, and less time devoted to repair and maintenance, all of which lead to increases in accidents.

During business downturns, all of these elements

are reversed-younger and less experienced workers are laid off while older and more experienced

employees are retained, plant operations slow

down, and more effort is devoted to repair and

maintenance (254,444).

OTA has compared injury rates with several

measures of the business cycle. Figure 2-2 shows

data for the BLS total recordable injury rate and
Ch. 2—Data on Occupational Injuries and Illnesses ● 35

Figure 2.2.—lnjury Rates and Unemployment—

Private Sector: 1972.83

— Injury rate ---- Unemployment rate

the unemployment rate for 1972 to 1983. The total

recordable injury rate declined from 1973 to 1975

and again from 1979 to 1982, simultaneously with

rising unemployment rates. In addition, the rising injury rates from 1975 to 1979 coincided with

declining unemployment rates. From 1982 to

1983, the total injury rate and unemployment

went down slightly, while the lost workday rate

stayed the same.

In figure 2-3, these two variables have been

plotted against each other, with the unemployment rate on the horizontal (or x-axis) and the

injury rate on the vertical (or y-axis). Examination of this figure reveals an apparent inverse relationship between injury rates and unemployment.

That is, as unemployment rises in a recession, injury rates decline.

Another possible measure of the business cycle is to examine the level of employment, as opposed to the unemployment rate. This must be

done carefully because in the last few years, the

changes in the level of employment have not been

the same in all industries. In fact, from 1979 to

1982, employment in the more hazardous manufacturing and construction industries declined,

while employment in the other major private sector industry groups has stayed the same or increased. Figures 2-4 and 2-5 show the relationship

between employment and lost-workday injury

Figure 2-3.– Injury Rates and UnemploymentPrivate Sector: 1972-83

Unemployment rate (percent)

Figure 2.4.—Lost-Workday Rate and Employment—

Construction: 1972.83

0.0 ‘ ‘ 2.0 4.0 6.0

Employment (millions)

rates in construction and manufacturing alone.

Again there appears to be a close relationship. As

employment rises, so do injury rates.

OSHA has suggested to OTA that the recent

injury rate declines are not the result of the current recession because “BLS has estimated that

only 16 percent of the decline in injury rates in

1982 can be attributed to a disproportionate drop

in hours worked in high-risk industries” (34). BLS,

however, noted that the procedure they used for

this calculation, “does not take into account . . .

other factors which may also affect the rate, but
36 Preventing Illness and Injury in the Workplace

Figure 2.5. -Lost. Workday Rate and Employment—

0.0 ‘ ‘

which have not . .

8.0 12.0 16.0 20.0 24.0

Employment (millions)

been measured, such as the demographic composition of the workforce, worker

education, improved safety measures, the role of

State and Federal agency compliance programs,

technological change, etc” (607).

But the “demographic composition of the workforce” and “technological change” are two

variables that are particularly affected by the business cycle. In addition, the amount of overtime

worked, the pace of production, and the rate of

new hires are affected by the business cycle. The

BLS procedure for calculating the effects of the

decline in hours worked may not fully capture the

effects of these other variables on injury rates.

Additional analysis using variables that directly

measure the new hire rate, the number of overtime hours, the rate of production, and capacity

utilization in specific industries may clarify this

relationship further. (Examination of the influence

of new hires is, however, made more difficult because BLS no longer publishes statistics on labor

turnover, which included the new hire rate. ) But

at present, it appears that the effect of the recent

recession, especially in construction and manufacturing, is the most important factor behind the

injury rate declines from 1979 to 1983. In addition, it appears that national injury rates since

1972 have been largely related to the level of business activity.

When the OSH Act was enacted in 1970, Congress placed the legal responsibility for preventing occupational injuries and illnesses with

employers and created several agencies, including

NIOSH and OSHA, to conduct research and administer regulations. Employees, of course, also

have a personal stake in preventing disease and

injury in the workplace. Some detailed studies on

the effectiveness of OSHA in improving the efforts of employers and employees have found a

favorable but small impact, while other studies

have not found any effect (see ch, 13 for a summary). Even the favorable effects detected in several studies may not be large enough to be discerned in national injury statistics, while shifts in

the nature of the injury rate-business cycle relationship may be difficult to detect. However, it

is clear that if any improvements have been made

they have not been large.

Accuracy of Occupation Injury Estimates

Questions raised about the accuracy of estimates based on employer-maintained injury

records have intensified with the current administration’s inspection targeting system. OTA has

conducted a limited comparison of data from the

BLS Annual Survey and from the BLS Supplementary Data System (SDS) to see if they are consistent. Data were available only for years before

the implementation of the new inspection targeting system and the conclusions of this analysis,

therefore, apply just to that period.

Some States participating in the SDS report

only lost-workday cases while others report all

cases involving either lost workdays or medical

treatment. OTA found that for States reporting

only lost-workday cases to the SDS, the numbers

of cases were not consistently higher or lower

from either SDS or the Annual Survey, after adjusting for the minimum waiting periods (as

defined by State workers’ compensation). Although there were some differences between these

two data sources, these differences were not consistent from one State to the next. In States that

report all cases involving either lost workdays or

medical treatment to the SDS, consistently more

cases were reported to the SDS than would be expected from the Annual Survey data.
Ch. 2—Data on Occupational Injuries and Illnesses ● 3 7

In another analysis, OTA compared BLS Annual Survey injury rates with rates calculated from

the estimates of the NHIS. This analysis compared

information derived from employer records (BLS)

with that from workers and their families (NHIS).

This comparison showed that, in recent years,

overall injury rates based on the NHIS are about

one-third higher than those from the BLS Annual

Survey.

Differences among the various sources could

arise from different methodologies and, as such,

OCCUPATIONAL ILLNESSE S

There is substantially less quantitative information on occupational illnesses than on injuries. Although employers are required to include occupational illnesses in their records, it is well accepted

that employer records and the BLS Annual Survey estimates, which are based on employer

records, underestimate the magnitude of the occupational disease problem. This is because many

occupational diseases are indistinguishable from

non-occupational diseases, because they often become manifest only after a latent period, and because of a general lack of recognition of the occupational causes of many diseases. For 1983, the

BLS Annual Survey estimate is about 106,000 occupational illnesses, but that is almost certainly

an underestimate.

The most commonly quoted estimates are that

up to 100,000 deaths due to illness and 390,000

illness cases occur each year as a result of workplace conditions. Although the estimate of 390,000

cases was cited during the Congressional debates

about the Occupational Safety and Health Act,

OTA has not been able to determine the exact

methods for deriving this estimate.

The estimate of 100,000 deaths was derived first

by a crude technique using the results of three epidemiologic studies and later by an analysis of information in a 1951 British death registry. As a

result, the 100, 000-deaths figure can only be considered an estimate, but it is unclear to what extent the figure is biased. Peter Barth and Allen

Hunt (46) have reported other estimates that range

may not be worrisome. Or it could be that employers do not report certain types of injuries to

the BLS Annual Survey even though they do submit reports to workers’ compensation. As discussed above, the differences between the BLS Annual Survey and the NHIS may also stem from

employers labeling some injuries as cases involving only first-aid treatment, even though employees and other family members consider them serious enough to report to the NHIS.

from 10,000 deaths to 210,000 deaths. More accurate estimates are difficult because of a general

lack of information on both historical and current worker exposures, incomplete knowledge of

the deleterious effects of workplace exposures, and

the general problems of assigning single “causes”

to diseases created by multiple factors.

Although it is well accepted that employer

records understate the magnitude of the occupational illness problem, it is very difficult to quantify the extent of this understatement. One pilot

study, conducted by David Discher and colleagues

(143), explored the usefulness of medical examinations and industrial hygiene surveys for identifying the extent of occupational illness in several industries. The researchers administered

medical exams to workers in four industries, conducted industrial hygiene surveys, and classified

a total of 451 medical conditions among the surveyed workers as probably linked to occupational

exposures. Eighty-nine percent of these 451 conditions were not noted in either the workers’ compensation claims or the employers’ logs. Although

this percentage of non-reporting may not be applicable to all workplaces, this study did reveal a

large number of cases that were not being recognized by employers and were thus not recorded.

It is also interesting to note that the BLS Supplementary Data System reported only 234 workers’ compensation cases for all cancers in 1980.

This can be compared to the range of estimates

for occupational cancer caused by asbestos alone,
38 ● Preventing Illness and Injury in the Workplace

which is between 4,000 and 12,000 cases annually.

Even if the SDS total is adjusted for all the states

that do not currently report to the SDS, there appears to be substantial underreporting of cancer

cases to workers’ compensation programs.

The absence of an accurate accounting of the

occupational disease toll highlights the need for

accurate and comprehensive information on employee exposures, both to provide a basis for more

accurate disease estimates and to measure the effectiveness of current occupational health efforts.

CONCLUSIO N

OTA estimates that about 6,000 U.S. workers

die each year from occupational injuries, or about

25 each working day. In addition, each working

day there are at least 10,000 injuries that result

in lost worktime, and about 45,000 that result in

restricted activity or that require medical attention. Estimates of the number of nonfatal injuries

vary partly because of differences in the definitions of injuries, the population universes, and

methods of estimation. Some discrepancies may

also be due to differences in how employers and

employees interpret the severity of an injury.

Injury and fatality rates are affected by a number of factors. These include the effects of the business cycle, and various changes in the administration of workers’ compensation, the practice of

occupational medicine, and other socioeconomic

factors, as well as the possible effectiveness of

OSHA in reducing injury frequency and severity.

The NIOSH National Occupational Hazard Survey (564,565,566) and National Occupational Exposure Survey can provide information on the

number of employees potentially exposed to hazardous substances, but they do not provide any

information on the level of exposure and only

limited information on the duration of exposure.

Although it may be possible to use the data collected by OSHA during inspections to develop

estimates of worker exposures, such analysis depends on further research.

.

OTA finds that the effect of the recent recession, especially in construction and manufacturing, is the most important factor behind the injury rate declines from 1979 to 1983, In addition,

it appears that most of the changes in national

injury rates since 1972 are associated with changes

in business activity.

Compared with occupational injuries, there is

substantially less quantitative information on occupational illnesses, Although employers are required to include occupational illnesses in their

records, it is well accepted that employer records

underestimate the magnitude of the occupational

disease problem. However, it is difficult to quantify the extent of this understatement.
3.

Health Hazard Identification
3-1.

3-2.

3-3.

3-4.

3-5.

3-6.

3-7.

3-8.

. . . . . . . .

. . . . . . . .

TABLES

. . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . .

united States, 1982 . . . . . . . . . . . . . . . . . . . . .

some Occupational cancer Hazards . . . . . . . .

Neurologic Effects of Occupational Toxins . .

The Ten Leading Work-Related Diseases and Injuries:

. . . .

. . . .

. . . .

Substances for Which NIOSH Has Recommended

Prevent Skin Disorders ● . . . . . . . . . . . . . . . . . . . . . .

Workplace Agents That Induce skin Disorders . .

42,

42

43

45

45

48

4 9

5 2

5 2

5 4

6 2

6 3

. . . . . . . . . . . . . . . . . . . . . . 4 3

. . . . . . . . . . . . . . . . . . . . . . 4 6

5 0

Exposure Limits to

. . . . . . . . . . . . . . . . . . . . . . 5 1

. . . . . . . . . . . . . . . . . . . . . . 5 1

Industries at Highest Risk for occupational Skin Diseases 5 2

General Classification of Tests Available to Determine Properties Related

to Carcinogenicity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

Advantages and Disadvantages of Case-Control and Cohort Studies . . . . . . 59
Health Hazard Identification

Since work occupies a central place in most

lives, it is not surprising that it is related to many

afflictions, nor that in one form or another it contributes to diseases of every system of the body.

Some diseases are relatively easily linked to

workplace conditions, either because the diseases

themselves are distinct or relatively rare, or because the particular workplace conditions differ

greatly from ordinary conditions of daily life.

Other diseases are associated with either the workplace or other activities, or with both; pinning

down causes and preventive strategies of those

diseases is more complicated.

Occupational diseases have been recognized for

centuries, although definitions of disease and ill

health have changed over time. Society—less willing to accept adverse effects of any kind and

knowing that much disease is preventable—no

longer believes poor health to be a necessary concomitant of work.

While attention often focuses on new hazards,

and in identifying and preventing more subtle,

previously unnoticed effects, professionals in occupational safety and health also continue to deal

with many cases of well-known occupational diseases. The still-frequent occurrence of many of

these older diseases represents a failure to use

already available knowledge.

Health hazards include those identified as present in the workplace, those present but unidentified, and new hazards, not yet introduced there.

The identified hazards include exposures to physical agents such as radiation and noise, and exposures to some substances, including chemicals,

metals, minerals, and vegetable dusts. Present,

unidentified hazards may be many or few. Continued observation of workers and testing of substances are necessary to determine what exposures

are hazardous. Testing of new substances should

reduce the number of hazards introduced unknowingly into the workplace.

Traditionally, physicians and groups of workers have been the sources of information leading

to the association of particular hazards with disease. “Factory fever” (typhus), “mad hatters” (victims of mercury poisoning), and “wrist drop” (lead

poisoning) were related to workplace exposures

through observation. Recent years have seen increasing importance being given to epidemiology—

the study of the distribution of diseases—and

toxicology— the study of the dangerous properties of substances—in identifying workplace

hazards.

Case reports from doctors, workers, and employers can be valuable sources of information

on hazards and serve to generate hypotheses for

larger studies. But inadequacies in the training of

physicians, both those who practice occupational

medicine and those in general practice, limit identification hazards through case reports.

Epidemiology relies on observations or suggestions of possible associations between exposures

or behaviors and disease for hypothesis generation. It has limitations in the kinds and magnitudes of effects it can detect, but it can provide

the most convincing evidence of associations between exposures and behaviors and health. The

strengths of epidemiology still remain to be exploited, and much remains to be learned about

diseases and syndromes that are widespread in the

population.

Toxicology can garner useful information about

the possible effects of substances, but large toxicologic studies are expensive, require years to

complete, and produce information that is sometimes difficult to apply to human exposures. Making risk assessments from animal data involves

both technical problems and assumptions. Although continued attention to toxicology and risk

assessment may reduce technical controversies,

the assumptions about the predictive value of

various tests are likely to remain in dispute.

41
42 . Preventing Illness and Injury in the Workplace

Epidemiology and toxicology have not been the

panacea for solving workplace health problems

that some envisioned. The limitations of both

argue for a continuing role for occupational medicine in hazard recognition as well as treating

workers. That role can be enhanced during the

education of physicians.

Computerized information about workplace exposures and workers’ health forms the basis for surveillance systems that aim to identify health hazards.

OCCUPATIONAL DISEASE

Some diseases are always or nearly always

caused by conditions at work. These diseases represent relatively easy cases for health and safety

professionals because they can be readily linked

to particular working conditions. In general, identification of workplace hazards is facilitated by:

● conditions at work that differ greatly from

the normal conditions of daily life, and

● the presence of distinctive or very rare diseases in these exposed workers.

Examples from the early part of this century are

the occurrence of “phossy jaw” among phosphorus match workers, the diseases of radium dial

painters, and “wrist drop” caused by lead poisoning among adult workers. More recently, mesothelioma and liver angiosarcoma both occur so

rarely in the nonexposed population that when

cases were observed among asbestos and vinyl

chloride workers, respectively, questions of occupational causation were immediately raised and

relatively quickly answered.

But relationships between work and diseases are

not always so clear-cut. In fact, it is probably

more frequent that working conditions directly

cause or contribute to diseases that are also related

Occupational health surveillance is the source of

both great promise and great controversy. It can be

used to identify the causes of occupational illness,

setting the stage for preventing further illness. But

there are practical difficulties in implementing systems that will be statistically useful, concerns about

company liabilities after discovering a possible relationship, and concerns that efforts will be made to

substitute surveillance activities for preventive efforts and installation of appropriate controls.

to other human activities. In other words, workplace exposures c

creased incidence

diseases also regu

ulation.

ause workers to suffer an inof disease, even though these

arly occur in the general popFor example, most lung cancer occurs in smokers, and it is accepted that there is a causal relationship between cigarettes and lung cancer. Some

substances encountered in the workplace are also

known lung carcinogens because they increase the

occurrence of lung cancer in nonsmokers as well

as in smokers. In addition, smoking and other carcinogens may also act together to cause cancer.

However, deciding which exposure(s) caused lung

cancer in a particular smoking worker is a difficult task.

Hazards that increase the incidence of common

diseases can be best identified using the techniques

of epidemiology. But even after studies have

shown a link between exposures and increased disease incidence for a group of workers, it often remains impossible to determine, for any individual worker, that his or her disease was caused by

occupational exposures.

MAJOR CLASSES OF OCCUPATIONAL DISEASES

Occupational diseases have been recognized as Ramazzini, the 18th-century physician often called

such for centuries. References to almost all classes the father of occupational medicine. Since then,

and types of diseases appear in the works of the definition of disease in general has changed,
—. —

Ch. 3—Health Hazard Identification ● 43

———

as has the perception of work-relatedness. Society

is less willing to accept adverse effects of any kind.

Because so much disease is known to be preventable, poor health is no longer taken as a concomitant of certain occupations. Our increasing

ability to detect subtle effects allows us to broaden

our efforts in prevention.

There is something seductive about new risks,

and a tendency to focus on new hazards. Although in one sense occupational health is dealing with new and ever-subtler effects, the old diseases are still around, in greater numbers than is

generally perceived. In 1979, an estimated 84,000

active workers suffered from acute byssinosis and

at least 35,000 employed or retired workers were

disabled from cotton dust-related disease. In 1978,

an estimated 59,000 workers were thought to suffer from silicosis. Even as new and perhaps scientifically and medically more intriguing conditions

become issues in occupational health, the old

problems require continued vigilance.

To guide its research priorities, the National Institute for Occupational Safety and Health (NIOSH)

has developed a list of 10 groups of occupational

diseases (table 3-1). Although termed the “Ten

Leading” work-related diseases, the list includes

nearly all categories of health effects that have

ever been linked to workplace conditions.

Six of the categories of diseases listed by NIOSH

are discussed in this chapter. Traumatic injuries

are the subject of the next chapter, and noiseinduced hearing loss is discussed in chapter 8. The

reader is referred to the recent textbooks by Levy

and Wegman (269) and Rem, et al. (396), for details of disease and hazard identification.

Respiratory Disorders

The lungs and other parts of the respiratory

tract come in contact with all manner of airborne

materials in the workplace. Gases, vapors, fumes,

fibers, and particles all may be inhaled, Of all

health effects, occupationally related cancers of

the respiratory tract receive the greatest attention,

but they are not the only serious respiratory conditions associated with the workplace, and certainly not the most widespread. Other responses

of the respiratory system may be acute irritation,

immunologic or allergic reactions, or chronic

changes in the tissues that line the respiratory

Table 3.1 .—The Ten Leading Work-Related Diseases and Injuries:

United States, 19828

-.

Type of disorder/inju”~ Exam Dies

1

2

3,

4.

5.

6

7,

8,

9.

10,

.—

Occupational lung diseases

Musculosketal injuries

Occupational cancers (other

Amputations, fractures, eye

lacerations, and traumatic

Cardiovascular diseases

Disorders of reproduction

Neurotoxic disorders

asbestos is, byssinosis, silicosis, coal

workers’ pneumoconiosis, lung cancer,

occupational asthma

disorders of the back, trunk, upper

extremity, neck, lower extremity;

traumatically induced Raynaud’s

phenomenon

than lung) leukemia, mesothelioma; cancers of the

bladder, nose, and liver

oss, —

deaths

hypertension, coronary artery disease,

acute myocardial infarction

infertility, spontaneous abortion,

teratogenesis

peripheral neuropathy, toxic encephalitis,

psychoses, extreme personality changes

(exposure-related)

Notse-induced loss of hearing —

Dermatologic conditions dermatosis, burns (scaldings), chemical

burns, contusions (abrasions)

Psychologic disorders neuroses, personality disorders,

alcoholism, drug dependency — — ‘The condlt!ons I Isted u rider each category are to be v!ewed as sdwfed examples, not cornprehenswe defl n It Ions of the category

SOURCE (563)
44 ● Preventing Illness and Injury in the Workplace

tract. Some conditions that begin as acute problems progress to chronic states, perhaps the best

known being byssinosis–or “brown lung” disease.

NIOSH has made formal recommendations for

maximum exposure levels to 60 substances, based

on their effects on the respiratory system. That

number is greater than the substances cited for

any other organ system.

Chronic Conditions

The most serious conditions are pneumoconioses, chronic conditions occurring generally

after years of exposure to very fine dusts. The

tissue reacts by thickening, producing a condition

called “pulmonary fibrosis. ” The best known

pneumoconioses are asbestosis, silicosis, and coal

workers’ pneumoconiosis (“black lung”), but similar conditions may be produced by a number of

different materials, such as talc and kaolin.

Pneumoconioses are characterized by coughing

and shortness of breath, which grow worse over

time, followed in the later stages by signs of heart

failure and eventually ending in death.

Chronic bronchitis can be caused by a number

of occupational hazards but, as the commonest

chronic response of the respiratory tract, is also

brought on by nonoccupational causes. It may

also be multicausal, as many diseases are, with

nonoccupational factors (particularly cigarette

smoking) interacting with occupational exposures

to cause disease.

Emphysema is another chronic condition in response to many different stimuli. Though there

are undoubtedly cases of occupational origin, few

convincing, direct correlations between workplace

exposures and this disease are known.

Beryllium disease (berylliosis) is an example of

granuloma formation in response to foreign

bodies in the lungs. Granulomas form when body

cells responding to an “inciting agent” become surrounded by bundles of collagen (a type of connective tissue).

Acute Conditions

Inflammations and irritations of the tissues lining the respiratory tract occur in response to many

inhaled substances. The upper respiratory tract—

the nose, throat, and larynx-is the most frequent

site of irritation, It is susceptible to highly soluble irritants, such as ammonia, hydrogen chloride,

and hydrogen fluoride-gases commonly encountered in industry.

Irritants that are less soluble tend to travel farther down the respiratory tract before they are

absorbed entirely, causing irritation in the middle as well as the upper respiratory tract. Chlorine, fluorine, and sulfur dioxide, all commonly

used chemicals, have such properties, The major

effect on the lungs is bronchoconstriction.

Irritants of low volubility may cause only minor upper respiratory tract problems, but their

delayed reaction deep in the lungs, which may occur as much as a day later, can be very serious.

Ozone, oxides of nitrogen, and phosgene—again,

commonly encountered in workplaces—are the

most important hazards in this class.

Asthma and “hypersensitivity pneumonitis” are

two manifestations of immunologic or allergic

type reactions. Bronchial asthma, a condition

affecting perhaps 4 percent of the U.S. population, is also prevalent among certain occupational

groups. Asthma is a generalized obstruction of the

airways in an allergic type of response to some

substance. Causes can be of bacterial or animal

(e.g., animal dander, small insects, bee toxin) or

plant (e.g., flour, grain dust, fungi, cotton, flax,

tea fluff, wood dusts) or chemical (e.g., formaldehyde, certain pesticides, some metals, some

acids) origin. Often the condition develops only

after a period of sensitization, and for some

agents, very high percentages of those exposed become sensitized. It has been reported that nearly

all workers in power plants along the Mississippi

River become sensitized to river flies (396).

The causes of hypersensitivity pneumonitis include a variety of organic materials, commonly

fungi or bacteria. Beginning with coughing, but

without the wheezing associated with asthma,

these disorders can become chronic and disabling. Such conditions as “farmer’s lung, ” “mushroom picker’s lung, “ “cheese washer’s lung, ” and

“paprika splitter’s lung” fall into this category.

Byssinosis deserves particular recognition. (For

further discussion of this disease, see ch. 5.)

Though it has been known in some sense as a dis-
—

Ch. 3—Health Hazard Identification ● 4 5

ease associated with cotton and other textile fibers

for hundreds of years, it was ignored as an occupational disease in this country until fairly

recently. The disease begins with tightness in the

chest and a decrease in lung capacity upon exposure. The condition is most severe on Monday

mornings. Over a period of years, chronic obstructive lung disease may develop, partially or

totally disabling the worker. The earlier stages of

the disease are thought to be reversible, but the

later stages are not. The exact etiologic agent of

byssinosis is not known, but various chemicals

and organic substances have been suggested.

Musculoskeletal Disorders

Low back pain is responsible for more lost

work-time than any other medical condition except upper respiratory tract ailments. In terms of

treatment and workers’ compensation, low back

pain is the costliest occupational ailment. More

than half of all workers will experience low back

pain of some kind sometime in their working lives,

but the percentage of those cases associated with

the workplace is unclear.

Low back pain may develop progressively and

insidiously, or it may come on with immediacy.

Pain may be dull and aching, with fatigue and

stiffness, or sharp and crippling. Surprisingly little is known about the physiologic and physical

causes underlying back pain. Circumstantial evidence implicates intervertebral discs in many

cases. (Discs are cartilaginous structures separating the vertebrae of the spine. ) In extreme cases,

a disc may rupture, but physical signs that would

explain the pain are usually absent. Episodes of

pain, which last usually from a few days to a few

weeks, generally resolve with rest. Months or

years may pass without another attack.

Muscles, tendons, ligaments, and bones can

also be damaged by traumatic events or by repeated strains over a long period. Although muscle pulls and tears have been recognized for years,

the “repetitive motion disorders"—those caused

b y repeated, often forceful motions, mainly of

parts of the arm —have come to attention more

recently (see “Carpal Tunnel Syndrome, ” ch. 7),

Much assembly-line work and food processing,

for example, is characterized by repetitive,

strenuous, awkward tasks. The prevalence of

repetitive motion disorders is unknown, but more

and more industries are recognizing that they have

such problems.

Cancer

Table 3-2 is a list of recognized occupational

cancer hazards. In most cases, there is convincing or very strong evidence that the listed substances have caused cancer in humans. Inspection

of the table shows that many of these substances

cause common cancers, for instance, of the lung

and skin. Except for a few specific and infrequent

cancers, there is no way to tell, from examining

a cancer patient, what agent(s), exposure(s), or

behavior(s) caused the tumor.

The most detailed information about an occupational cancer hazard involves asbestos. The unfolding of that story illustrates the time necessary

for association to be accepted and some controversies about occupational illness. Individual case

studies and reviews of case series relating exposures to asbestos with cancer began to appear in

the literature in the 1930s (161). According to

Selikoff (430), however, the establishment of an

association between occupational exposure to asbestos and lung cancer depended on a classic study

by Doll in 1955 (147).

Although asbestos was positively identified as

a cause of lung cancer in the 1950s, and exposure

to it was known to be widespread, no published

estimate of its impact on nationwide mortality

was available until 1978, when two estimates were

made. Selikoff (555) estimated that the annual

number of asbestos-related cancer deaths was

about 50,000. His estimate elicited little public attention.

The other 1978 estimate (555), entitled “Estimates of the Fraction of Cancer in the United

States Related to Occupational Factors, ” was prepared by the National Cancer Institute, the National Institute for Environmental Health Sciences,

and NIOSH. Ten employees of those institutions

were listed as contributors to the “estimates paper, ” which was placed in an Occupational Safety

and Health Administration (OSHA) hearing record about that agency’s proposed generic cancer
46 . Preventing Illness and Injury in the Workplace

Table 3=2.—Some Occupational Cancer Hazards

Agent Cancer site or type Type of workers exposed

Acrylonitrile . . . . . . . . . . . . . .

4-aminobiphenyl . . . . . . . . . . .

Arsenic and certain arsenic

compounds . . . . . . . . . . . . .

Asbestos . . . . . . . . . . . . . . . . .

Auramine and the

manufacture of

auramine . . . . . . . . . . . . . . .

Benzene. . . . . . . . . . . . ... , . .

Benzidine. . . . . . . . . . . . . . . . .

Beryllium and certain

beryllium compounds . . . .

Bis(chloromethy l)ether

(BCME) . . . . . . . . . . . . . . . . .

Cadmium and certain

cadmium compounds . . . .

Carbon tetrachloride . . . . . . .

Chloromethyl methyl ether

(CMME) . . . . . . . . . . . . . . . . .

Chromium and certain

chromium compounds. . . .

Coal tar pitch volatiles . . . . .

Coke oven emissions . . . . . .

Dimethyl sulphate . . . . . . . . .

Epichlorohydrin . . . . . . . . ., .

Ethylene oxide . . . . . . . . . . . .

Hematite and underground

hematite mining . . . . . . . . .

Isopropyl oils and the

manufacture of isopropyl

oils . . . . . . . . . . . . . . . . . . . .

Mustard gas . . . . . . . . . . . . . .

2-naphthyiamine . . . . . . . . . . .

Nickel (certain compounds)

and nickel refining . . . . . . .

Polychlorinated biphenyls

(PCBs) . . . . . . . . . . . . . . . . .

Lung, colon

Bladder

Lung, skin, scrotum,

lymphatic system,

hemangiosarcoma of the

liver

Lung, larynx, GI tract,

pleural and peritoneal

mesothelioma

Bladder

Leukemia

Bladder, pancreas

Lung

Lung

Lung,

Liver

Lung

Lung,

Lung,

Lung,

Lung

Lung,

prostate

nasal sinuses

scrotum

kidney, prostate

leukemia

Leukemia, stomach

Lung

Paranasal sinuses

Respiratory tract

Bladder, pancreas

Nasal cavity, lung,

Melanoma

larynx

Manufacturers of apparel, carpeting, blankets, draperies,

synthetic furs and wigs

Chemical workers

Workers in the metallurgical industries, sheep-dip workers,

pesticide production workers, copper smelter workers,

vineyard workers, insecticide makers and sprayers,

tanners, miners (gold miners)

Asbestos factory workers, textile workers, rubber-tire

manufacturing industry workers, miners, insulation

workers, shipyard workers

Dyestuffs manufacturers, rubber workers, textile dyers, paint

manufacturers

Rubber-tire manufacturing industry workers, painters, shoe

manufacturing workers, rubber cement workers, glue and

varnish workers, distillers, shoemakers, plastics workers,

chemical workers

Dyeworkers, chemical workers

Beryllium workers, electronics workers, missile parts

producers

Workers in plants producing anion-exchange resins

(chemical workers)

Cadmium production workers, metallurgical workers,

electroplating industry workers, chemical workers, jewelry

workers, nuclear workers, pigment workers, battery

workers

Plastic workers, dry cleaners

Chemical workers, workers in plants producing ionexchange resin

Chromate-producing industry workers, acetylene and aniline

workers, bleachers, glass, pottery, pigment, and linoleum

workers

Steel industry workers, aluminum potroom workers, foundry

workers

Steel industry workers, coke plant workers

Chemical workers, drug makers, dyemakers

Chemical workers

Hospital workers, research lab workers, beekeepers,

fumigators

Miners

isopropyl oil workers

Production workers

Dyeworkers, rubber-tire manufacturing industry workers,

chemical workers, manufacturers of coal gas, nickel

refiners, copper smelters, electrolysis workers

Nickel refiners

PCBS workers
Ch. 3—Health Hazard Identification . 47

Table 3-2.—continued

Agent Cancer site or type Type of workers exposed

Radiation, ionizing . . . . . . . . .

Radiation, ultraviolet . . . . . . .

Soots, tars, mineral oils . . . .

Thorium dioxide . . . . . . . . . . .

Vinyl chloride . . . . . . . . . . . . .

Agent(s) not identified . . . . .

SOURCE (542)

Skin, pancreas, brain,

stomach, breast, salivary

glands, thyroid, GI tract,

bronchus, Iymphoid

tissue, leukemia,

multiple myeloma

Skin

Skin, lung, bladder, GI

tract

Liver, kidney, larynx,

leukemia

Liver, brain, lung,

hematolymphopoietic

system, breast

Pancreas

Stomach

Brain, stomach

Hematolymphopoietic

system

Bladder

Eye, kidney, lung

Leukemia, brain

Colon, brain

Esophagus, stomach, lung

Uranium miners, radiologists, radiographers, luminous dial

painters

Farmers, sailors, arc welders

Construction workers, roofers, chimney sweeps, machinists

Chemical workers, steelworkers, ceramic makers,

incandescent lamp makers, nuclear reactor workers, gas

mantle makers, metal refiners, vacuum tube makers

Plastics factory workers, vinyl chloride polymerization plant

workers

Chemists

Coal miners

Petrochemical industry

Rubber industry workers

Printing pressmen

Chemical workers

Farmers

Pattern and model makers

Oil refinerv workers

Photo credit OSHA, Office of Inforrnation and Consumer Affalrs

Shipbuilding operations present a variety of both safety and health hazards. During World War 11,

many workers were exposed to asbestos in naval shipyards
48 ● preventing Illness and Injury in the Workplace

policy (the “estimates paper” is available as an ap

pendix in Peto and Schneiderman (371)).

Had the paper been only deposited in the hearing record it might have passed largely unnoticed.

Its findings, however, were widely publicized

when then-Secretary of Health, Education, and

Welfare Joseph Califano cited them in a speech.

Based on the “estimates paper, ” he stated that

workplace exposures caused at least 20 percent

of all cancer in this country-with exposure to

asbestos alone responsible for 13 to 18 percent.

These projections were controversial as soon as

they were publicized, and they attracted many

critics. They also resulted in a spate of articles presenting other estimates of the cancer risk associated with occupational exposure to asbestos.

The subsequent papers can be divided into two

general groups. One group used methods similar

to the “estimates paper” to project numbers of cancer deaths based on estimates of workers exposed,

exposure rates, and mortality observed among insulation workers highly exposed to asbestos. A

second type of paper measured the number of

deaths from mesotheliomas, which are closely

associated with asbestos exposure, and then

multiplied that number by some factor to estimate

all asbestos-caused cancer deaths.

Methods similar to those employed in the 1978

paper generated three estimates of total asbestos

cancer mortality. Those estimates, lower than the

13 percent figure in the “estimates paper, ” were

1 percent (162), 2 percent (216) and 3 percent

(331). The different numbers reflect the authors’

different estimates about the numbers of heavily

exposed workers—estimates that can be criticized

because they were not made on the basis of actual measurements. As that sort of information

does not exist, however, documented assumptions

are the best that can be provided.

In the case of asbestos, scientists interested in

extrapolating from study-generated data to estimates of national cancer mortality are aided by

the fact that asbestos causes asbestosis and mesotheliomas. Both those diseases are reasonably rare

and reasonably diagnostic for asbestos exposure.

Although both are subject to undercounting that

limits the accuracy of estimates based on them,

the estimates from them are congruent with those

based on the method used originally in the “estimates paper. ” Calculations based on numbers of

mesotheliomas and asbestosis produced estimates

of between 1 and 2 percent of all cancer deaths

being due to asbestos (148,212,294,370).

The consistency of the projections that asbestos

causes between 1 and 3 percent of current cancer

deaths (190) has a pronounced effect on estimates

of total occupationally related cancers. Most, but

not all, participants at an international conference

about occupational cancer agreed that workplace

exposures cause less than 5 percent (20,000 annual deaths) of U.S. cancer mortality (371).

Although this number is not as frightening as

saying asbestos causes 13 percent of cancer and

that workplace exposures cause at least 20 percent, and perhaps twice that figure, it is still a large

number of deaths. Furthermore, as representatives

from all sides—academe, labor, and management—agree, those cancers are preventable.

The amount of cancer that is associated with

workplace exposures is a significant part of the

current debate about the relative importance of

various factors in cancer causation (see (18), the

exchange of facts and opinions in ‘letters” Science

224:659 et seq., especially (154) and (19)).

Reproductive Disorders

The possibility that people’s occupations are

leading to problems for an unborn generation is

frightening. It is increasingly a concern among

workers, and attention to reproductive disorders

on the part of scientists is intensifying. Few facts

are available to either support or quell the fears

that a great many reproductive hazards are present in the workplace. Relatively few instances of

harm are known when compared with the known

effects of workplace hazards on workers themselves.

Initial concerns about reproductive health focused almost exclusively on women. Exposure to

the high levels of lead common at the beginning

of this century were known to cause menstrual

disorders, sterility, miscarriages, and stillbirths.

Much more recently, concern has been extended

to males. One episode provided the catalyst. In
—

Ch. 3—Health Hazard Identification ● 49

the late 1970s, a number of men working in the

manufacture of dibromochloropropane (DBCP),

a pesticide, were unable to father children, Investigation revealed severely depressed sperm production.

Damage can occur in males and females in a

number of ways. In men, successful reproduction

depends on proper functioning of the prostate, on

libido, and on erection and ejaculation. The production and viability of sperm can be affected by

damage to the sperm-producing cells or to the

sperm as they develop.

In women, damage can occur in the reproductive cells, the oviducts, the endometrium, or to

ovarian function. During fetal development in the

uterus, humans are most vulnerable to environmental insults. Death, irreversible structural

changes (teratogenesis), and growth retardation

are the main classes of effects. More difficult to

measure or prove are subtle deficits in intellectual capacity and functioning.

The effects of lead have been mentioned. At

least one form of another heavy metal, mercury,

is a known teratogen. Certain pesticides—DBCP

and Kepone for instance-affect sperm production. Ionizing radiation has a variety of effects,

particularly on fetuses—causing growth retardation, for instance, or microcephaly, or having

latent effects, such as leukemias that develop during childhood. A few organic solvents and pharmaceuticals also are known to affect reproductive health. In all, relatively little is known about

the extent of workplace-induced reproductive

damage, but efforts to find out more are under

way. A current OTA assessment scheduled for

completion in 1985, “Reproductive Health Hazards in the Workplace, ” addresses this issue.

Necrologic Disorders

A wide variety of metals and organic compounds act on the nervous system to cause physical and behavioral problems. Since many bodily

functions require the participation of nerves,

nerve impairment affects not only sensory abilities, but motor (muscular) ability as well as the

functioning of organs.

Lead is the best-known neurotoxin in the workplace. More than a million American workers are

exposed currently. Mercury, manganese, and

other metals, as well as organic solvents and

organophosphate insecticides, also pose neurotoxic risks. Table 3-3 lists some known neurotoxins and their effects.

Neurotoxins can damage the myelin sheath surrounding the nerve fiber or the nerve cell itself.

Toxins can also interfere with the production and

functioning of “neurotransmitters,” chemicals produced in the body that are necessary for proper

functioning of the nerves. ’some necrologic impairment is reversible, but damaged nerve cells

have limited capacity for regeneration and repair.

Neurotoxins affect the parts of the nervous system to different degrees. The most commonly

affected are peripheral nerves-those of the extremities. Hands and feet are often the first

symptomatic zones, and numbness and tingling

the first signs. Weakness in the hands and feet follows, and then difficulty walking and an inability

to grasp heavy objects. Other symptoms include

impaired vibratory sense, loss of touch perception, and tremors of the hand and other parts of

the body.

A host of behavioral changes can also result

from necrologic insults: Slow response time, impaired hand-eye coordination, irritability, lack of

concentration, continual emotional instability,

and impairment of recent memory area few such

signs. (Lewis Carroll’s “Mad Hatter” may have

been a victim of the necrologic effects of mercury

used in making felt hats. )

Most neurotoxins act through common pathways, though some have more specific effects:

Carbon disulfide, for instance, acts at all levels

on the central nervous system, but also causes

conditions as extreme as acute psychosis.

Skin Disorders

The skin, the largest organ of the body, provides the first line of defense between workers and

their environment. Because it is readily observable,

recognition of a problem is relatively easy. For
50 . Preventing Illness and Injury in the Workplace

Table 3-3.—Neurologic Effects of Occupational Toxins

Peripheral Effects

Effect Toxin Comments

Motor neuropathy . . . . . . . . . . . . . . . . Lead

Mixed sensorimotor neuropathy . . . . Acrylamide

Arsenic

Carbon disulfide

Carbon monoxide

DDT

N-hexane and methyl

n-butyl ketone (MBK)

Mercury

Primarily wrist extensors; wrist drop and ankle drop rare

Ataxia common; desquamation of hands and soles;

sweating of palms

Distal parethesias earliest symptom; painful limbs,

especially in calves; hyperpathia of feet; weakness

prominent in legs

Peripheral neuropathy rather mild; CNS effects more

important

Seen only after severe intoxication

Only seen with ingestions

Distal paresthesia and motor weakness; weight loss,

fatigue, and muscle cramps common

Predominantly distal sensory involvement

Other Manifestatlons

Manifestation Agent Manifestation Agent

Ataxic gait , . . . . . . . . . . . . .Acrylamide

Chlordane

Chlordecone (Kepone)

DDT

N-hexane

Manganese

Mercury (especially with

methyl mercury)

Methyl n-butyl ketone (MBK)

Methyl chloride

Toluene

Bladder neuropathy. . . . . . . Dimethylaminopro pionit ri te

(DMAPN)

Constricted visual fields . . Mercury

Cranial neuropathy . . . . . . Carbon disulfide

Trichloroethylene

Headache . . . . . . . . . . . . . . . Lead

Nickel

Impaired visual acuity ... , N-hexane

Mercury

Methanol

Increased intracranial

pressure . . . . . . . . . . . . . . Lead

Organotin compounds

Myoclonus . . . . . . . . . . . . . . Benzene hexachloride

Mercury

Nystagmus . . . . . . . . . . . . . . Mercury

Opsoclonus . . . . . . . . . . . . . Chlordecone (Kepone)

Paraplegia. . . . . . . . . . . . . . . Organotin compounds

Parkinsonism . . . . . . . . . . . . Carbon disulfide

Carbon monoxide

Manganese

Seizures . . . . . . . . . . . . . . . . Lead

Organic mercurial

Organochlorine insecticides

Organotin compounds

Tremor. . . . . . . . . . . . . . . . . . Carbon disulfide

Chlordecone (Kepone)

DDT

Manganese

Mercury

NOTE: This table Includes most, but not all, of the neurotoxic substances associated with Ilsted conditions.

SOURCE: (39a)

both these reasons, skin disorders account for

nearly half of all reported occupationally related

illnesses in the United States. NIOSH has recommended maximum exposure levels for about 40

agents based on their effects on the skin (see table

3-4).

Chemical, physical, and biological agents, mechanical factors, and plant and wood substances

are known to cause occupationally related skin

disorders (see table 3-5). There is probably no industry without some potential for exposure to one

or more of these agents. The industries with the

highest risk for skin disorders are listed in table

3-6. Although caused by a large number of agents,

both biological and chemical, skin diseases are

manifested in a relatively limited number of clinical symptoms: contact dermatitis, infection, pilosebaceous follicle abnormalities, pigment disorders, and cancers.

Contact dermatitis accounts for 90 percent of

all occupational skin disorders. The most common manifestations of contact dermatitis are redness and swelling, and vesiculation (e.g., a poison

ivy rash) in more severe cases. Contact dermatitis

may be an allergic reaction or simply due to an

irritant.

Bacterial, fungal, and viral infections may be

contracted from customers or clients by such pro-
Ch. 3—Health Hazard Identification ● 5 1

Table 3-4.—Substances for Which

NIOSH Has Recommended Exposure

Limits to Prevent Skin Disorders

Acrylamide

Alkanes:

Pentane

Hexane

Heptane

Octane

Arsenic, inorganic compounds

Benzoyl peroxide

Benzyl chloride

Carbon black

Chromium (Vi)

Coal tar products

Cresol

Epichlorohydrin

Ethylene dibromide

Fibrous glass (dust)

Glycidyl ethers:

Allylglycidyl ether (AGE)

n-Butyl glycidyl ether (BGE)

Di-2-,3-epoxypropyl ether (DGE)

Isopropyl glycidyl ether (lGE)

Phenyl glycidyl ether (PGE)

Hydrazines:

Hydrazine

1,1-dimethyl hydrazine

Phenyl hydrazine

Methyl hydrazine

Hydrogen fluoride

Hydroquinone

Nickel, inorganic and compounds

Phenol

Polychlorinated biphenyls:

Chlorodiphenyl (42°/0)

Chlorodiphenyl (54°/0)

Refined petroleum solvent

Thiols:

Butyl mercaptan (1-butanethiol)

Methyl mercaptan (1-methanethiol)

Ethyl mercaptan (1-ethanethiol)

Tin, organic compounds

Tungsten:

insoluble compounds

soluble compounds

Vanadium

SOURCE Adapted from (12Sa)

fessionals as barbers and hairdressers and by hospital workers. Staphylococcus and streptococcus

bacteria may cause a range of skin conditions

from superficial to those of deep skin layers. More

serious bacterial infections, such as anthrax in

sheep handlers and animal hide workers, are

rarer.

Fungal infections often arise in moist, warm

environments. Ringworm and Candida albicans

infections are common examples. Candida infecTable 3-5.—Workpiace Agents That

induce Skin Disorders

Chemical agents

Rhus oleoresin (poison ivy and oak)

Acids

Alkalis

Solvents

oils

Soaps and detergents

Plastics

Resins

Paraphenylenediamine

Chromates

Acrylates

Nickel compounds

Rubber chemicals

Petroleum products not used as solvents

Glass dust

Plant and Wood Substances

Pink rot celery

Citrus fruit

Physical Agents

Ionizing and nonionizing radiation

Wind

Sunlight

Temperature extremes

Humidity

Biological Agents

Bacteria

Viruses

Fungi

Ectoparasites (mites, ticks, fleas, etc.)

Biting animals

Mechanical factors

Pressure

Friction

Vibration

SOURCE: (23a).

tion is common in workers, such as dishwashers,

who are frequently exposed to water, because

moist conditions favor the fungus’ growth. Viral

infections are acquired by contact with other people and are a particular hazard for workers exposed intimately to other individuals in the course

of their work, such as health care workers.

Pilosebaceous follicle abnormalities, generally

acne-like lesions, occur after exposures to heavy

oils and certain chemicals, particularly chlorinated

aromatic hydrocarbons. The example currently

most discussed is chloracne after exposure to

chlorinated dioxins, either in the manufacturing

process, or, most dramatically, after industrial accidents involving the generation and release of

large amounts of the chemical. Chloracne may

persist for 10 yearn or more after exposure ceases.
52 . Preventing Illness and Injury in the Workplace

Table 3-6.—industries at Highest Risk for Occupational Skin Diseases

Annual reported

incidence rate Target population Incidence of lost

(per 1,000 (rounded to workdays per

Industry workers) x nearest 1 ,000) x Severity a x Durationb

= industry per year

Poultry dressing plant s 16,4 89,800 030 10.0 4,405

Meat packing plants 72 164,300 0.31 4,3 1,561

Fabricated rubber products 55 103,200 0.22 11,5 1,424

Leather tanning and finishing 21,2 22,900 0.34 8.3 1,392

Ophthalmic goods 8.5 38,000 0.52 8.3 1,390

Plating and polishing 8.3 61,400 0.28 9.0 1,270

Frozen fruits and vegetables 7,2 43,200 0.31 12,1 1,153

Internal combustion engines 5.5 75,700 027 8.8 999

Canned and cured seafoods 5.6 19,700 0,36 23,7 934

Carburetors, pistons, rings, valves 70 29,400 024 17.9 895

Chemical preparation s 8.3 36,700 0.23 12.3 855

Boat building and repairing 11.1 48,000 0.22 7,4 854

aseverlty ,s defined by number Of lost-workday cases dwlded by fOtd Wnbw Of Cases HI that Industry

bDura[lon IS [he number of lost workdays per IOSt workday case

SOURCE (23a)

Pigment disorders occur when melanin produc- versible or not, depending on the causative agent

tion is either increased or decreased through ex- and on the severity of the insult. Other changes

posures to chemicals or from a traumatic event—a in skin color are due to staining of various layers

burn, for instance. Loss of pigment may be re- by such substances as heavy metals.

KNOWN AND UNKNOWN HEALTH HAZARD S

Health hazards are agents that can cause disease in people exposed to them. In terms of occupational health, there are three kinds:

●

●

●

identified hazards known to be present in the

workplace;

hazards that are present in the workplace but

that have not been identified as causes of disease; and

new substances or processes not yet introduced

into the workplace, that will be hazardous to

human health.

This section reviews the findings that led to

some associations being made between particular diseases and workplace hazards, as well as the

methods currently employed to identify hazards.

Identified Hazards

Diseases associated with mining and metalworking have been recognized for many years,

to some extent because of the antiquity of those

trades. Some industrial chemicals are known to

cause a variety of diseases, and energy from all

parts of the electromagnetic spectrum is a hazard

under particular circumstances. As the following

examples show, associations between agents and

diseases have been made by people from all sectors of society based on laboratory information

as well as observations of human illness.

Physical Agents

Sources of ionizing radiation are increasingly

common in the workplace. X-ray apparatus and

radioisotopes are widely used, and nuclear powerplants and scientific research also involve potential exposures to ionizing radiation. Very high

doses of radiation can kill workers within a few

days, but of greater concern, because the events

are more likely, is low-level exposures, which may

last for several years and may cause cancer. The

deleterious effects of radiation were discovered

from observations of disease among early workers in the field and confirmed by analyses of the

survivors of Nagasaki and Hiroshima.
Ch. 3—Health Hazard Identification 53

—

Nonionizing radiations include ultraviolet, infrared, microwave, and laser. All present hazards

for workers’ eyes, and there is continued interest

in and study about other effects from microwave

radiation. Ultraviolet and infrared radiation as

well as intense visible light are generated in welding, and welders’ goggles and helmets are designed

to protect against such hazards.

Also in the category of physical agents is noise,

which, especially if it is loud and continuous,

causes progressive hearing loss. The impact of occupational noise is difficult to separate from the

effects of aging, but many studies have shown

workplace noise is a hazard to hearing. (See ch.

8 for a discussion of the role of personal protective equipment in preventing hearing loss. )

Vibration, often experienced as a result of the

use of handtools, causes a number of musculoskeletal disorders (see ch. 7).

Heat, cold, and pressure encountered in underwater work are also hazards. These have been

associated with particular jobs for a very long

time, and many of their effects are visible during

or soon after exposure.

Metals

Hunter (218) divides hazardous metals into

three groups. Those known since ancient times,

such as lead and mercury, were long ago associated with disease. According to Hamilton (1922,

quoted in 218), the first legislation directed against

an occupational hazard was drafted in 1665 in

Idria, now part of Yugoslavia. The workday for

cinnebar (mercury ore) miners was restricted to

6 hours as a preventive measure to reduce the

occurrence of tremors. Mercury continues to

cause concern today as an environmental contaminant, and it is especially dangerous in the

organic (methylmercury) form.

Hunter’s second group, the “other metals, ” are

arsenic, phosphorus, and zinc. He points out that

the grouping is arbitrary in that arsenic is a

metalloid and phosphorus a nonmetal. These

three elements have been in common industrial

use for a few centuries, and all have caused illness and death. The recognition of phosphorus

as the cause of “phossy jaw” among matchmakers

(see box A) led to the substitution of a safe form

Box A.—’‘Phossy Jaw”

Phossy jaw was a disease that resulted from

inhaling yellow or white phosphorus fumes that

penetrated any defective tooth and killed cells

in the jaw and surrounding tissues. Invasion of

the dead areas by germs from the mouth led to

suppurating infection, swelling, and intense pain.

Death could result from blood poisoning; surgical treatment, which often included removal of

the jaw, was incapacitating and disfiguring. The

disease was first diagnosed in workers in European match factories in the middle of the 19th

century.

Up through 1908, there was no recognition of

phossy jaw as an occupational health problem

in the United States. A Bureau of Labor study

that year of the wages of women and children

in the match industry revealed 150 cases of

phossy jaw. Two years later, the Bureau issued

“Phosphorus Poisoning in the Match Industry in

the United States.”

One of the surest forms of controlling exposures to hazardous substances is to substitute a

less hazardous chemical. Phossy jaw was conquered by substituting a different form of phosphorus for the “white phosphorus” commonly

used in matches. The Diamond Match Co.,

which held the American patent for the safe form

(sesquisulphide), waived its patent rights and

made the safe substitute available to the entire

industry (199). In 1912, Congress passed the

“Esch Act,” which levied a tax on white phosphorus matches, driving them from the market.

of phosphorus in matches. These three metals still

occupy important places in industry and in agricultural products.

The third group of metals are those recently introduced into commerce, including some important in advanced metallurgic technologies and the

nuclear industry. Toxic effects are definitely associated with some—beryllium, cadmium, chromium, manganese, nickel, osmium, platinum, radium, ruthenium, selenium, tellurium, thallium,

thorium, uranium, and vanadium. In some measure, because these substances were introduced into

the workplace when industrial hygiene measures

were more common, exposure to many of them
54 ● Preventing Illness and Injury in the Workplace

has been well controlled (218). Also important to

controlling exposures to some of these metals is

their great expense; uncontrolled losses through

spills or into the atmosphere as vapors, fumes,

or dusts entail financial losses as well as health

hazards.

Many metals are worked in industry with no

reported toxic effects. Cesium, cerium, columbium, gallium, germanium, hafnium, iridium,

lanthanum, molybdenum, rhenium, rhodium,

rubidium, strontium, tantalum, titanium, tungsten, and zirconium, for example, have not been

associated with illness in workers (218). Exposures

to many such metals are controlled by standard

industrial hygiene practices, and the fact that some

of these metals are very expensive also encourages

reduced exposures.

Hunter (218) is a good source of historical information about the uses and effects of the various

metals and about British approaches to controlling exposures. Rem, et al. (396), discusses clinical symptoms and treatments as well as U.S. approaches to control, and Levy and Wegman (269)

provide a lively introduction to the occupational

health and industrial hygiene problems associated

with the metals, with less emphasis on clinical

detail than Rem. Tyrer and Lee (483) summarize

information about acute and chronic health effects of the metals and list recommended and regulatory limits to exposure.

Dusts and Fibers

The hazards of mineral dusts have been known

since mining began. Both silica dust and coal dust

cause lung diseases. The widespread use of silica

as an abrasive for “sand blasting” and other

polishing results in many thousands of American

workers being exposed to mineral dusts that are

associated with lung diseases. In addition, cotton

dust and asbestos are important as causes of byssinosis and asbestosis, respectively.

Chemicals

Because of the explosion of organic chemistry

(chemistry that involves carbon) in the last 100

years, thousands of new chemical substances have

been introduced into the workplace. Currently

there are more than 55,000 chemicals listed in the

Environmental Protection Agency’s (EPA) inventory of Chemical Substances, which is a compilation of chemicals in commerce. About 100 new

chemicals are introduced to commerce each month

(547a). Many of these substances–pesticides of

various kinds and drugs-are designed to alter

normal biological functions, and it is no surprise

that some have been found to cause cancer and

other diseases, and that these substances are of

special concern (542).

Some of the now-known hazards, such as vinyl

chloride monomer, have been discovered as a result of workers who have become sick. (See ch.

5 for a fuller discussion. ) Several years before an

alert physician noted an excess of rare liver tumors

in vinyl chloride workers, the results of an animal test of the same chemical were announced at

a scientific meeting. The animal tests also showed

the chemical to be a liver carcinogen. It can be

argued that had the animal results been taken seriously, exposure to vinyl chloride would have been

reduced sooner. As it happened, the existence of

the animal studies may have been a factor in the

rapid regulatory process that led to significant reductions in vinyl chloride exposures.

Acrylonitrile is a commonly used plastic that,

like vinyl chloride, presents little hazard after it

is polymerized. However, animal studies showed

that acrylonitrile monomers are carcinogenic, and

a follow-on epidemiologic study showed an excess of cancer among acrylonitrile production

workers. Regulations restricting exposures to the

substance were drafted by OSHA; unlike most

other OSHA health regulations, the final standard for acrylonitrile was not challenged in court.

There must have been a number of reasons for

that success, and included in them were probably

the congruence between the results of the animal

and human studies and the fact that the methods

developed to control vinyl chloride exposures

were directly applicable to the control of acrylonitrile.

Methods for Detection of Present,

Unidentified Hazards

Epidemiology, toxicology, and occupational

medicine provide the means for identifying the

causes of occupational illnesses. In the traditional,
Ch. 3—Health Hazard Identification 55

idealized view of the process, physicians generate hypotheses about possible associations between workplace exposures and subsequent disease. Hypotheses are tested in epidemiologic

studies so that the associations can be characterized in statements of statistical probability.

The traditional role of toxicology has been to

provide information about the mechanisms of disease causation, the end results of which are

detected by physicians and studied by epidemiologists. Toxicology today is generally thought of

in different terms. Since the late 1960s and particularly through the 1970s, toxicology has been

seen as a way to identify chemical hazards before

their effects appear in humans. The most visible

toxicologic activities are the testing of chemicals

for carcinogenic properties in laboratory animals,

mainly rats and mice (542). The Federal Government, through the National Toxicology Program,

spent $31.6 million in 1983 on bioassays for that

purpose.

There is also a certain amount of research now

going on in development of short-term tests (so

named because they require significantly less than

the 2 to 5 years for an animal bioassay) as eventual replacements for and supplements to bioassays,

One of the most powerful methods of identifying associations between workplaces and diseases

is through workers themselves. For instance, the

pesticide dibromochloropropane was identified as

a cause of male sterility by workers talking to each

other. A possible relationship between office work

involving video display terminals and fetal malformations that is now being actively investigated

similarly derives from workers’ observations. In

many cases, workers’ comments to their physicians lead to epidemiologic and toxicologic investigations and to medical surveys to decide

whether a suspected association is real.

Toxicology

Toxicology is the testing of chemicals in animals, plants, or lower forms of life to detect

biological effects. In addition to questioning what

kinds of effects are produced and under what exposure conditions, toxicologists also investigate

the mechanisms by which substances cause damage. That information is especially important in

efforts to predict the likely toxic effects of substances that have not yet been tested. Toxicology

can be subdivided in a number of ways. Here,

testing for acute toxicities is discussed first, followed by a section on methods for investigating

chronic toxicities—carcinogenesis, mutagenesis,

and teratogenesis.

Acute Toxicity Testing. —Chemical burns and

immediate difficulty in breathing as a result of inhalation of a substance are examples of acute toxic

effects. Animal testing of chemicals for toxicity

has produced a voluminous data set.

Increasing concern about animal welfare is

causing reconsideration of animal testing methods. For instance, one of the most venerable acute

toxicity tests is the LD50 test. Designed in the

1920s, the test involves the use of 50 to 100 animals to decide what amount of substance will

cause the death of 50 percent of the animals. This

method is coming under increased attack, however, as being imprecise and causing more animal suffering than is necessary. OTA is studying

the use of alternatives to animals in research and

testing. The report from that project, expected in

1985, will discuss the pros and cons of various

animal tests and alternatives to animal tests.

NIOSH’s 1980 Registry of Toxic Effects of

Chemical Substances lists 45,156 substances. Included for most of the substances is the LD50 estimate of the amount that will kill half of a population of test animals. In addition, information

about the toxic effects of the substance on animal skin and eyes is also commonly reported.

Dosages of ingested or injected substances necessary to cause effects in animals are expressed

as the weight of the substance administered

divided by the animal’s body weight, i.e., milligrams of substance/body weight in grams or

kilograms. When the substance is inhaled, the

dangerous concentrations are expressed as parts

per million in air or as the weight of the substance

per cubic meter of air. These values provide data

for making estimates of the biological effects of

the substance in humans. Almost always, safety

factors of 10 or 100 are used in setting acceptable

limits for workers. That is, if 100 parts per million of a substance causes breathing difficulties

in animals, a prudent policy would be to limit

worker exposures to 10 or 1 part per million.
56 . Preventing Illness and Injury in the Workplace

Chronic Toxicity Testing.—Structural activity

relationship (SAR) analysis, chronic animal bioassays, and short-term tests are the main tools of

toxicology (see table 3-7) as it relates to carcinogens, and, in general, chronic health hazard

identification (542,547a). Finding a toxic effect in

humans is far more convincing evidence about the

seriousness of a hazard than detecting a toxic effect in animals, which, in turn, is more convincing than results from short-term tests. The weakest

evidence is that derived from projections from

structural activity relationships. Although the

Federal effort devoted to chronic toxicities-mutagenicity and teratogenicity as well as carcinogenicity—is largely directed toward identifying

carcinogens, there are some minor stirrings of effort to broaden beyond cancer (595).

Carcinogenicity has received the lion’s share of

OSHA’s attention to health hazards. Of the fewer

than two dozen chemicals regulated through new,

permanent OSHA standards, all but two—lead

and cotton dust—have been carcinogens.

Extrapolation problems—that is, how knowledge of effects in animals are projected to make

predictions for people and how exposure levels

in test animals are related to human exposure

levels–bedevil the use of animal test data. OTA

(542) has already discussed those problems and

various approaches to reconciling them.

1) Structural activity relationship analysis, SAR

uses known information about the properties of

a substance to gain insight into the possible and

probable effects of the substance on human beings. It is a new and still uncertain technique. Substances whose molecular structures resemble those

of known toxic substances come under greater suspicion than those whose structures do not. No

firm conclusions can be made based on these analyses except in the rare cases where all previously

known members of an entire class of chemicals

are known to be hazardous. In general, positive

results are taken to indicate a need for further

testing,

SAR has found most use in making estimates

of the toxicity of “new” chemicals, when no test

data are available. However, even there the scientific underpinnings of SAR are considered by some

to be very weak, and the conclusions based on

it are hotly argued (547a).

2) Short-term tests. Short-term tests encompass

a large collection of methods for measuring toxicity in lower life forms-viruses, bacteria, and

lower plants and animals, such as fruit flies-in

cultured cells, or, in a few cases, in specific organ

systems of laboratory rodents (542). Since their

introduction about 15 years ago, they have been

characterized as holding great promise for toxicology. A cynic might say that they always will.

Table 3-7.–General Classification of Tests Available to Determine Properties Related to Carcinogenicity

Method System Time required Basis for test

Structural activity

relationship (SAR)

analysis ‘Paper chemistry”

Basic laboratory tests

Short-term tests Bacteria, yeast, cultured

cells, intact animals

Bioassay Intact animals (rats,

mice)

Epidemiology Humans

Days Chemicals with Iike

structures interact

Weeks similarly with DNA

Generally few weeks Chemical interaction with

(range 1 day to 8 DNA can be measured

months) m biological systems

2 to 5 years Chemicals that cause

tumors m animals

may cause tumors in

humans

Months to Iifetimes Chemicals that cause

cancer can be

detected m studies of

human populations

Structure resembles

(positive) or does not

resemble (negative)

structure of known

carcinogen

Chemical causes

(positive) or does not

cause (negative) a

response known to be

caused by carcinogens

Chemical causes

(positive) or does not

cause (negative)

Increased incidence of

tumors

Chemical IS associated

(positive) or is not

associated (negative)

with an increased

incidence of cancer

Chemical may be

hazardous; that

determination requires

further testing

Chemical IS a potential

carcinogen

Chemical IS recognized

as a carcinogen in

that species and as a

potential human

carcinogen

Chemical IS recognized

as a human

carcinogen

SOURCE Adapted from (542)
Ch. 3—Health Hazard Identification 57

Running counter to that lack of enthusiasm, recent spectacular advances in molecular biology

suggest that short-term tests will grow in importance. As more and more insight into the molecular basis of carcinogenesis accumulates, along with

rapid advances in methods to manipulate DNA

and other cellular components (542,548), improved short-term tests should follow. The limitations and uncertainties of testing substances in

whole-animal bioassays are built into the method

itself. No such limits bound potential short-term

tests for discerning interactions between chemical and cellular components. Of course, it will

always be possible to argue that the short-term

test system is not sufficiently parallel to human

biology to serve as a guide to human risk estimation.

The critical issue for development of short-term

tests is defining their current and ultimate value

in policymaking. The first step is to find out how

well the results of a test represent the “truth,” a

process referred to as validation. Truth is usually

relative, and in the case of the carcinogenic potential of chemicals, the convenient measuring

stick for truth is the bioassay, with its attendant

limitations (542). The acceptability of bioassay

results as a guide to making decisions about health

hazards appears, sometimes at least, to be tied to

the financial interest or disinterest of individuals

and organizations in the substances identified as

carcinogens.

There is little hope that a single short-term test

will ever suffice as a reliable predictor of toxicity

in human beings, and hope is pinned on the development of a battery of tests. Years of discussion and argument will undoubtedly precede the

acceptance by scientists and regulators of any set

of tests. And even then, a “generally accepted”

test battery will be challenged in specifics, much

as evidence from bioassays currently is.

The development of reliable short-term tests

may actually enhance the value of bioassays,

which will always find a place in toxicologic

testing. Short-term tests can increase the knowledge base for deciding which chemicals should be

tested in animals, and can shed light on the probable mechanisms of action of each chemical.

3) Bioassays. The bioassay is the mainstay of

toxicology today. For some questions, answers

involving the biology of whole animals are essential. The technique involves exposing a population of laboratory animals, usually rats and mice,

to a suspect toxic agent. After an appropriate

time, about 2 years for carcinogenicity, the disease incidence in the the treated population is

compared with the disease incidence in a population of untreated controls. The premise underlying

the mammoth effort in bioassays is that evidence

of disease in animals is applicable to predictions

for people; in fact, substances known to be carcinogens in humans also cause cancer in animals.

An entire branch of risk assessment has grown

up around the quantitative predictions of effects

in human beings based on animal evidence, In the

combination of bioassay and risk assessment has

lain the hope of perfectly protecting workers and

the public from chemical carcinogenesis before effects appear. On general principles, this appealingly simple system may still hold promise for setting and defending regulatory goals, but its

systematic failure to guide regulatory efforts in

specific instances has led to disillusionment.

The technical problems encountered in conducting bioassays--including questions about high

doses, and the impossibility of knowing which extrapolation model is most appropriate—plague

risk assessment. Equally or more important are

the assumptions involved. For instance, apparently endless arguments have gone on about

whether liver tumors in mice mean anything in

terms of human risk; the argument has not been

settled by experimentation but is silenced by convention (542).

Formaldehyde is a case in point. There is general agreement that formaldehyde is an animal

carcinogen. The bioassay was carried out by industry’s own toxicology laboratory. But in the

final analysis, industry objected to regulating formaldehyde on the basis of the bioassay, and assessments produced by different organizations

varied in the amounts of human risk they predicted.
58 ● Preventing Illness and Injury in the Workplace

Epidemiology

The importance accorded epidemiology reflects

a trend toward more systematic, scientific study

of disease. The desire to base conclusions about

causality on something more than individual observation and intuition-the two most valuable

tools of the clinician—calls for describing associations quantitatively, both in terms of strength

of association and in terms of the probability that

the association is not simply one of chance. Careful epidemiologic investigations have confirmed

important suspicions about work-related illnesses.

The now universally acknowledged case against

asbestos is built on epidemiologic studies.

The strengths of epidemiology still remain to

be exploited. A great deal needs to be learned

about diseases and syndromes that are widespread

in the population. Certain chronic conditions

(cancers in particular) and heart disease are known

to be associated with various occupations. The

means exists, through the Surveillance, Epidemiology, and End Results Program of the National

Cancer Institute (542,683), to enter about onetenth of all U.S. cancer cases on tumor registries

as they are diagnosed. This system provides the

ability to set up large case-control studies with

relative ease. (See box B.)

Cohort studies of large industrial populations—

which can be assembled by corporations and/or

unions and facilitated by workplace surveillance

systems that have been installed by many companies to track and store various sorts of data—

also yield valuable information. (These surveillance systems are discussed further in the “Occupational Medicine” section. )

Government Records. —An important and frustrating feature of epidemiology in the United

States is the difficulty of locating and tracking

people. In a cohort study, it is critical that the

maximum number of cohort members be located.

If the cohort contains workers employed at a particular site S, 10, or 20 years ago, many will have

moved. In a case-control study, members of either population may be identified through hospital records, and the recorded addresses may no

longer be current. In either type of study, the

epidemiologist often needs to locate people for interview and examination.

There are standard methods for locating people in this mobile society. Asking at places of employment and using telephone and city directories

are common. Mail sent to the last known address

frequently reaches the person. In difficult cases,

the epidemiologists can hire private detectives or

credit bureaus to locate persons. The so-called

NIOSH-window facilitates some occupational epidemiology studies. Investigators who are allowed

to use it can supply a name and some other identifying information (such as the Social Security

number) to the Internal Revenue Service, and the

agency provides the person’s current address.

Members of the OTA Advisory Panel for this assessment reported that there is some confusion

about who can and cannot use the NIOSH window and under what conditions.

The Federal Government collects information

about places of employment and about what

hazards or substances are present in them. Such

records have obvious usefulness for epidemiology,

providing a quick method for identifying persons

who may have been exposed to a substance. However, all the record systems have flaws that restrict their usefulness (542,557). The recommendations made by the Committee to Coordinate

Environmental and Related Programs (CCERP)

of the Department of Health and Human Services provide an excellent grounding for questions

about the current systems and suggestions for

changes.

The National Death Index (NDI) can tell epidemiologists that a person is dead and which State

(or other) department of vital statistics holds the

death certificate. This speeds up the retrieval of

information for studies, but the NDI does not actually provide information on the cause of death

and underlying causes.

Section 8(e) of the Toxic Substances Control

Act (TSCA) requires that manufacturers report

to EPA on chemical substances that pose significant risks to human health or the environment.

Some companies voluntarily report these results

to NIOSH and OSHA. In practice, this reporting

requirement means that an employer that carries

out a short-term test, a bioassay, or an epidemiologic study that shows a health risk must report

it to the EPA. EPA prepares a report on each 8(e)
Ch. 3—Health Hazard Identification ● 5 9

Case-Control Studies

.

In a case-control study, persons with the disease under study (cases) are compared with individuals

without the disease (controls) with respect to risk factors that are judged relevant. Some authors label

this study design “retrospective” because the presence or absence of the predisposing risk factor is determined for a time in the past. However, in some cases the presence of the factor and the disease are ascertained simultaneously.

The choice of appropriate controls is rarely without problems. Often, for practical reasons, controls are chosen from hospital records. But they may not be representative of the general population,

and they therefore may introduct “selection bias” (2$2).

General Considerations

In case-control and cohort studies, the groups selected should be comparable in all characteristics

except the factor under investigation. In case-control studies, the groups should resemble each other except for the presence of the disease; in cohort studies, the study and comparison groups should be similar except for exposure to the suspect factor. Since this rarely is possible in practice, comparability between groups can be improved by either matching individual cases and controls (in case-control studies)

or by standard statistical adjustment procedures (in either case-control or cohort studies). Demographic

variables such as age, sex, race, or socioeconomic status are most commonly used for adjustment or

matching.

There are advantages and disadvantages in both types of study (see table 3-8). Case-control studies

tend to be less expensive to conduct, require relatively fewer individuals, and often have been especially

Table 3-8.-Advantages and Disadvantages of Case-Control and Cohort Studies

Type of study Advantages Disadvantages

Case-control . . . . . . . Relatively inexpensive Complete information about past exposures

often unavailable

Smaller number of subjects Biased recall

Relatively quick results Problems of selecting control group and

matching variables

Suitable for rare diseaes Only relative risk is yielded

Cohort . . . . . . . . . . . .Lack of bias in ascertainment of risk Possible bias in ascertainment of disease

factor status

incidence rates as well as relative risk are Large numbers of subjects required

yieided

Associations with other diseases as by- Long follow-up period

product can be discovered Problem of attrition

Changes over time in criteria and methods

Very costly

Difficulties in assigning people to correct

cohort

SOURCE: (542).
60 ● Preventing Illness and injury in the Workplace

notification and circulates it within the Agency

and to other Federal agencies, including OSHA

and NIOSH. In addition, periodically the reports

received over a period of time are bound together

for distribution to libraries. The 8(e) activities,

therefore, provide a way to disseminate health

hazard information rapidly.

Occupational Medicine

The field of occupational medicine has gone

through a series of changes during this century.

Not long ago, the clinician not only tended the

sick but also filled a number of other roles, investigating possible disease relationships and

fostering changes in the workplace. To a certain

extent, the role of the occupational physician was

altered by the rise of epidemiology and toxicology

as separate professions.

Epidemiology and toxicology have not been the

panacea for solving workplace health problems

that some envisioned. Toxicology is limited to

testing under conditions that cannot mimic complex human exposures and behaviors. Epidemiology cannot begin until it finds subjects for study,

and it relies on outside input—in particular, clinical observations of possible associations between

exposures or behaviors and disease—for hypothesis generation. It has limitations in the kinds and

magnitudes of effects it can detect. The limitations

of both toxicology and epidemiology argue for

a continuing role for occupational medicine in

hazard recognition as well as in treating workers.

Better use of physicians’ experience and insights

will depend on education. There are two categories: general education of physicians about occupational disease and injury, and specialized

education and training for practitioners of occupational medicine. An orientation toward occupational health is minimal at best, in most U.S. medical schools. Levy (269a) reports that only 5 0

percent of U.S. medical schools provided some

class time to occupational health during the 1977-

78 academic year. This has risen to 66 percent in

the 1982-83 academic year. However, the median

number of required class hours devoted to occupational health remained at 4 hours. Postgraduate,

specialty training in this country has traditionally

been subsumed under preventive medicine, and

centered in schools of public health. Recently increased emphasis has been placed on clinical experience in medical schools. The location of the

specialty courses is less important than making

sure the programs are well-taught and attractive

and that they provide clinical experience. The

NIOSH-supported Educational Resource Centers

(discussed in ch. 10) provide postgraduate education for physicians.

In the United States, the occupational medical

services are usually provided by physicians who

are directly employed by or under contract to

employers. Large companies frequently have onsite medical departments, staffed by physicians

and nurses. Medium-sized companies might have

the full-time services of an occupational health

nurse, and possibly, the part-time services of a

local physician. Small companies have only rarely

provided occupational medical services.

An alternative organizational model is found

in occupational medicine clinics, which have been

growing in the last few years. These clinics are

usually associated with a hospital or university

and provide examinations and treatment to workers. Clinics might, because of a larger patient load

and a staff that consequently sees more patients,

be able to to provide more knowledgeable care,

as well as improved physician training. In some

cases, the clinics’ staffs include not only doctors

and nurses, but also industrial hygienists and

safety engineers. The combination of staff from
Ch. 3—Healfh Hazard Identification ● 61

different disciplines can provide a critical mass for

a great deal of important activity in hazard identification and control.

These clinics also provide advantages to employers, especially small to medium-sized companies, that previously were not able to provide

occupational medical services to their workers.

In the words of the director of an occupational

health department at one hospital:

The larger corporations will undoubtedly continue to have in-plant occupational health services. But medium and smaller companies will be

forced to make an economic decision on whether

it is more advantageous to do it themselves or

farm the occupational health service to others

(Daniel Conrad, quoted in 338a).

Some hospitals are apparently establishing these

clinics in order to develop new sources of revenue. The staff of these clinics expect to be able

to conduct some research, as well as to provide

advice about prevention and medical care to employees (338a).

Medical Surveillance Systems. —Computerized

information systems have made it possible to store

massive amounts of data. Information about exposures in the workplace and the health records

of workers can form the basis for surveillance systems that aim to identify health hazards. Surveillance is defined as the “collection, collation, and

analysis of data and its dissemination to those

who need to know” (474). Public health surveillance techniques were developed in the last century to identify foci of pestilential diseases such

as cholera, smallpox, plague, and yellow fever,

so that appropriate control measures could be instituted. In the workplace, the value of surveillance is to alert workers and employers to unusual

patterns of morbidity or mortality.

Concerns today center on chronic rather than

acute diseases; the technical problems of linking

cause and effect are heightened by the remoteness

of disease from exposure. Computerized information systems in industry, including their use for

medical and exposure records, have enabled massive amounts of information to be stored and correlations to be produced.

In the occupational setting, the necessary components of surveillance are:

●

●

●

exposure information of some type;

records of health outcomes, which may include causes of death; and

background information about characteristics of each individual that might influence

susceptibility to disease.

Variations in epidemiologic surveillance systems have to do mainly with the quantity and type

of data in each category. “Exposure” can be quite

basic: for instance, knowing the plant within a

company, or the department within a plant, in

which a worker is employed, and updating it perhaps yearly. At the more comprehensive end of

the spectrum, exposure might contain continuous

records of personal and area monitors measuring

chemicals and other agents in the industrial environment.

Health outcomes may be ascertained from industrial health and accident insurance reports,

which record only the most serious events, These

can be supplemented by information gathered in

preemployment examinations and nonroutine

visits to physicians, as an intermediate approach.

At the extreme, to the above information could

be added the results of periodic medical screening for many diseases or other abnormalities. Basically, the simpler systems are considered passive,

using data collected for other purposes (personnel records, insurance data); systems can be progressively more active in seeking data expressly

for health surveillance (312).

Routine analyses of data collected in surveillance systems are seldom sufficiently rigorous to

evaluate possible instances of occupational disease. Their broad, sweeping monitoring of health

events is more of a hypothesis-generating device.

It provides the means to make epidemiologic

studies as targeted and as timely as possible.

A sign of growing interest and activity in occupational health surveillance, and medical information systems in general, was a meeting of the

American Occupational Medical Association’s

Medical Information Systems Committee in 1981.

Papers presented at that meeting, which described
62 . Preventing Illness and Injury in the Workplace

19 such systems, were published as a supplement

in the October 1982 issue of the Journal of Occupational Medicine (238).

In the same issue of that journal, computer software companies advertised their ready-made programs for instituting surveillance systems. The

literature packets behind those systems, which appeared to be directed at smaller companies, describe convenient ways to classify and store large

amounts of information about workplace exposures and employee health, What is missing, at

least in the prospecti, are discussions about the

ultimate value and potential contribution of such

information to detecting problems in the workplace. Although the systems may facilitate record keeping that already goes on, they may fail

to have a serious impact on safety and health, as

they are promoted to do.

Occupational health surveillance remains a

source of both great promise and great controversy. If it could be used just to identify the

causes of occupational illness, setting the stage for

preventing further illness, there would be little to

say against the idea. As a purely scientific concept, it is unassailable. In practice, from the point

of view of companies, the collection and particularly the analysis of data about exposures and

health outcomes raises legal issues of responsibility

and liability. From the employees’ point of view,

there is a fear that surveillance will be adopted

as an alternative to installation of controls.

There is anecdotal evidence that some companies that had maintained surveillance systems

have now dismantled them. Although the same

data may still be collected for administrative reasons, they are not being assembled in a form for

analysis of possible relationships between exposures and disease. This step may at least in part

stem from the unknown consequences of finding

the suggestion of a health problem—for instance,

a slight excess of some particular cancer. Further

study would certainly be necessary to confirm the

association, yet the liability associated with even

suspecting that a problem exists cannot be known

at this time.

Some employers are concerned that discovering a possible association may make them liable

in tort actions. In addition, section 8(e) of TSCA

requires reporting of such findings, making them

public and available to potential litigants. On the

other hand, some companies expect that acting

responsibly will provide some defense against tort

action. The problem of deciding how to use suspicions that may be generated by routine matching of health and surveillance information is a

very real one.

A second policy issue in this field concerns the

proliferation of data collection systems for health

and exposure information that are accompanying

the microcomputer age. There appears to be little

thought given to the ultimate value of these systems in improving workplace safety and health.

Certainly for small companies, the targets of much

advertising, the number of workers will be too

small ever to detect all but the most obvious excesses of disease. There may be scope for using

computer networks to pool data, but these activities bring their own problems. (See ch. 10. )

Another pertinent issue is the substitution of

surveillance for prevention, particularly prevention in the form of controls on workplace exposures. Union officials and many health professionals fear that the creation of surveillance

systems will lead to the impression that “something is being done” to improve health, resulting

in less emphasis on controls and paralyzing action against hazards until large numbers of people become sick or die.

New Hazards

In some measure, “familiarity breeds contempt”-

even when the subject is hazards-and there may

be a human tendency to fear new hazards more

than old ones. The emphasis placed on identifying and understanding “new” hazards grows

partly from that psychology and partly from the

realization that it is easier to control hazards

before they become established in commerce and

economically important.

Epidemiologic studies and occupational medicine are of no value in learning whether a new

agent is hazardous before people are exposed to

it. The introduction of a new substance or process into the workplace that is subsequently shown

to be a hazard must be regarded as a failure of
. .

— —-

preventive health measures. Analysis of the chemical structure of a new substance can be used to

estimate what toxic properties are associated with

it, but many people consider that technique to be

unreliable. Toxicologic techniques can be used to

learn about the hazards of new substances, but

the associated costs place some restrictions on

their use.

Toxicology costs money, and manufacturers

will not spend great sums on testing a newly developed chemical before they know there is a market for it. Some manufacturers argued during the

debate when the Toxic Substances Control Act

was passed that they did enough toxicologic

testing to be assured that new chemicals would

not pose unreasonable risks. TSCA set up two

programs to gather information about new

chemicals.

The Premanufacture Notification Program

The Toxic Substances Control Act requires that

manufacturers prepare a Premanufacture Notice

(PMN) and submit it to EPA at least 90 days

before starting manufacture of a chemical substance for use in commerce. The PMN is to contain any information available to the manufacturer about the toxicity of the chemical, Some

PMNs contain many items of information bearing on the properties of the new chemical, while

others contain none or only a few, and there are

disputes about how useful the reporting has been

to date (547a).

It is clear from EPA’s experience with the PMN

program that a common plain for potentially hazardous exposures to newly introduced substances

is in their manufacture. EPA has used formal and

informal regulatory procedures to reduce occupaSUMMAR Y

Preventing workplace-related disease requires

that associations between activities and exposures

and diseases be identified. The known health

hazards-extremes of heat and cold, radiation of

various kinds, noise, and some dusts, fumes, and

Ch. 3—Health Hazard Identification ● 6 3

tional exposures to chemicals described on PMNs

(547a), and it has established informal communications with OSHA and NIOSH staff about controls. For instance, EPA has required the use of

respirators in the manufacture of some new chemicals described on PMNs. According to EPA officials, the Agency consulted with NIOSH about

appropriate respirators.

The PMN program provides an important opportunity to identify hazards before they become

established in the workplace. Although EPA regulated pesticides under a licensing law before

TSCA, its regulatory concern about other chemicals was restricted to those that became pollutants. Under the PMN program, it has authority

to regulate chemical substances before they get

into the workplace.

Significant New Uses

TSCA anticipated that the uses of a chemical

described on the PMN might not be associated

with an unreasonable risk, but that a different use,

called a “significant new use, ” might. TSCA

directs EPA to write a significant new use order

about new chemicals that fall into this category.

In practice, EPA has restricted some chemicals to

particular uses and required submission of more

data about the chemical before it could be more

widely used. One example of this process concerns

a surfactant for cleaning. Concerned about possible dermatologic effects, EPA did not object to

its use by professional cleaners, because those

workers could be instructed in the proper use.

However, if the surfactant is considered for use

in consumer products-a significant new use—

more information must be provided to EPA.

vapors from manufactured and naturally occurring substances—illustrate the diversity of exposures. In addition to identified hazards, present

but so-far-unidentified hazards are also a concern.

Finally, increasing attention is being focused on
64 ● Preventing Illness and Injury in the Workplace

— .

assessing the possible hazards of new substances

and processes before they are introduced into the

workplace.

Some health hazards that have been known for

centuries were obvious because of the particular

nature of the diseases; for instance, lead poisoning symptoms were sufficiently distinctive to make

the association between exposure to lead and disease apparent. Three disciplines—occupational

medicine, epidemiology, and toxicology—have

been important in describing associations. All

three are currently used in investigations of current exposures that may be hazardous. Toxicology

is especially important to learning about “new, ”

possibly hazardous substances before they are

introduced into the workplace.

Some of the most successful efforts at prevention, such as the marked reductions in exposure

to vinyl chloride, began with a physician noting

an unusual cluster of diseases. The importance of

this source of information draws attention to medical school teaching about the role of work in

health and disease. Unless medical students learn

the value of taking an occupational history as part

of the medical examination, associations may be

missed. Occupational physicians, familiar with

working conditions and exposures and often interacting with industrial hygienists and safety engineers, can be especially important in hazard identification. Workers’ own observations and

complaints, brought to the physician, are often

the first indication of a hazard.

Epidemiology is important less in initial identification of hazards than in providing evidence

for or against an association. In making decisions

about which hazards are “real, ” positive

epidemiologic studies are the most convincing evidence, but there are often protracted arguments

about the appropriateness of study methods and

the conclusions drawn. Companies, trade associations, unions, and government agencies all

commission epidemiologic studies and comment

on studies done by others. Government records,

which contain information about vital statistics

and locations, are especially useful in epidemiologic studies.

Toxicology provides information about the potential hazards of substances by testing them in

animals or other systems. With the passage of the

Toxic Substances Control Act, which requires that

companies notify the Environmental Protection

Agency of their intention to manufacture new

chemicals, the government is in a position to obtain information about chemicals before they enter

commerce. Although there are conflicts about

how much information EPA needs to protect

human health, it is clear that workplace exposures

are being identified as concerns in the case of some

new chemicals. Toxicology plays the central role

in identifying hazards from new chemicals.

TSCA also requires that companies notify EPA

about substances present in commerce that are

substantial risks, and the Agency then disseminates that information. All three disciplines—

occupational medicine, epidemiology, and toxicology—have contributed to the identification of

substantial risks. The NIOSH Health Hazard Evaluation program investigates possible associations

between exposures and illness at the request of

employers or employees or on its own initiative

(see ch. 10). It, too, relies on all three disciplines.

Hazard identification is not a smooth path;

arguments and conflicts abound. Evidence that

convinces some people leaves others unmoved.

The methods that were used in the past, improved

by better training and techniques, continue to be

of value today. More attention during the education of physicians and other medical personnel

to the influence of work on health, better use of

Federal records, where appropriate, to facilitate

epidemiology, and continual research to make

toxicology more predictive all offer opportunities

to improve hazard identification. However, as is

made clear in other parts of this assessment, hazard identification alone is not sufficient. Making

a decision to control a hazard requires that the

hazard be identified, but identification, by itself,

is not sufficient for control.
4.

Safety Hazard Identification
LIST OF TABLES

Table No.

. .

,.
4

Safety Hazard Identification;

Many safety hazards are obvious: a punch press

ram that descends every five seconds, a wet floor,

an unstable ladder. This is true at least for the

causes of acute injuries, though it is not necessarily true for cumulative injuries. In either case,

what is often unclear is the complex of events

through which the potential of the hazard is realized and an injury occurs. During this century the

theory of the cause of injuries has evolved, and

is still evolving, from attributing most injuries to

“unsafe acts” of workers, to identifying conditions

that increase the probability of an injury occurring. Under the first approach, the preventive

remedy is to install perfect workers in jobs. Under

the second—by identifying all possible contributing factors—preventive strategies can be applied, or at least considered, in different ways.

The causes of work-related injuries can be examined at two levels. The “macro” approach uses

aggregate statistics, such as those produced in the

Bureau of Labor Statistics’ Annual Survey, to examine the distribution of various types of injuries

according to several variables: industry, occupation, size of establishment, sex of worker, and

others (see ch. 2, Working Paper #l). These distributions provide general clues to injury causes.

The “’micro” level identifies specific injury causes.

An epidemiological approach analyzes sets of similar injury-related incidents to find common circumstances contributing to their cause. At the

most specific level, individual injury-related incidents are examined to determine cause; several

methods have been developed at this level.

The nearly 4,100 work-related fatalities (including heart attacks) that occurred in private sector

workplaces with 11 or more employees during

1982 were not evenly distributed over all industries (see table 4-1). Mining, accounting for 2 percent of employment, had 11 percent of the fatalities, Construction, 5 percent of employment,

accounted for 18 percent of reported on-the-job

deaths. The wholesale and retail trades represent

25 percent of employment, but recorded only 12

percent of the fatalities. Finance, insurance, and

real estate, along with the service industries, accounted for 31 percent of employment, but only

12 percent of fatalities.

A further breakdown reveals the injuries that

resulted in death by industry categories, both by

the distribution of causes within an industry category (see table 4-2), and by the distribution of

each cause across all categories (see table 4-3).

Overall, motor vehicle accidents account for 27

Table 4.1.–On-the-Job Fatalities by Industry Division, in Private-Sector Units with

11 Employees or More, 1982

Annual average

employment Fatalities

Industry division Number Percent Number Percent

Private sector (total) . . . . . . . . . . . 62,629,000 100 4,090 100

Agriculture, forestry,

and fishing . . . . . . . . . . . . . . . . . 729,000 1 180 4

Mining . . . . . . . . . . . . . . . . . . . . . . . 1,070,000 2 440 11

Construction . . . . . . . . . . . . . . . . . . 2,898,000 5 720 18

Manufacturing. . . . . . . . . . . . . . . . . 18,267,000 29 770 19

Transportation and

public utilities. . . . . . . . . . . . . . . 4,629,000 7 970 24

Wholesale and retail trade . . . . . . 15,603,000 25 490 12

Finance, insurance, and

real estate . . . . . . . . . . . . 4,252,000 7 100 2

Services . . . . . . . . . . . . . . . . . . . . . . 15,181,000 24 420 10

NOTE Because of rounding, components may not add to totals

SOURCE (608)

67
68 . Preventing Illness and Injury in the Workplace

Table 4-2.—Causes of On-the-Job Fatalities in Private-Sector Units with 11 Employees or More, by

Industry Division, with Distribution by Industry, 1981 and 1982a

I

I I

Causeb

Total—all causes . . . ....,-.., . . . . . . . . . . -

Over-the-road motor vehicles . . . . . . . . . , . . .

Falls . . . . . . . . . . . . . . . . . . . . . . . . . ... . . .

Heart attacks . . . . . . . . . . . . . . . . . . . . . . .

Industrial vehicles or equipment . . . . . . . . . . .

Nonaccidental injuries . . . . . . . . . . . . . . . . .

Struck by objects other than vehicles

or equipment . . . . . . . . . . . . . . . . . . . , . . .

Electrocutions . . . . . . ... . . . . . . . . . . , . .

Caught in, under, or between objects other

than vehicles or equipment. . . . . . . . . . . . . .

Aircraft crashes. . . . . . . . . . . . . . . . .

Fires ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Plant machinery operation ... . . . . . . . . . . .

Explosions . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Gas inhalations . . . . . . . . . . . . . . . . . . . . . . . . . .

Another . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

100

18

12

6

27

3

1

100

26

9

8

21

<1

100

52

6

6

3

2

100 100 100

35 29

9 10

23 16

0 9

8 15

0 2

0 5

17 2

7 7

1 <1

0 <1

0 1

0 1

<1 3

27

12

10

10

7

15

31

8

17

<1

20

10

10

9

2

20

5

12

4

30

6

6

9

4

5

11

1

16

8

5

6

4

3

3

2

2

3

1

2

8

1

0

1

4

3

5

7

1

2

3

3

4

1

1

2

2

1

3

 the industry division level sampling errors are large Therefore, the results are for both Years

rather than a comparison between them.

 as the object or event associated with the fatality.

 and nonmetal mining, and railroads for data are available

‘Excludes 

NOTE: Because of rounding, percentages may not 100

SOURCE (608)

Table 4-3.—Causes of On-the-Job Fatalities in Private-Sector Units with 11 Employees or More, by

industry Division, with Distribution by Cause, 1981 and 1982” -

I

Over-the-road motor vehicles . . . . . . . . . . . .

Falls . . . . . . . . . . . . . . ,, . .,,..,.,,

Heart attacks. ..., . . ..., ..., . . . . . . .,

Industrial vehicles or equipment . . . . . . . . . . .

Nonaccidental injuries . . . . . . . ..., ..., ...,

Struck by objects other than

vehicles or equipment .,,,. . . . . . . . . . . . .

Electrocutions . . . . . . . . ., . . . . . . .

Caught in, under, or between objects other

than vehicles or equipment. . . . . . . .

Aircraft crashes. . . . . . . . . . . . . . . ,.

Fires .. ...,,. . . . . . . . . . . . . . . . . . . . . . . . . . .

Plant machinery operations ..., . . . . ,...

Explosions . . ,. ....., . . . . . . . . . . . . .

Gas inhalations . . . . . . . . . . . . ., . . . . . . . . .

All other ., . . . . . . . . . . . . . . . . . . . . . . . . . . .

100

100

100

100

100

3

4

3

12

2

6 10 18 37 11 4

4 47 20 8 6 2

5 16 24 11 18 7

14 32 23 5 6 0

<1 <1 6 5 63 3

11

8

16

9

20

3

8

3

19

2

<1

6

5

8

100

100

10 16 33 8 31 0

4 34 21 18 3 0

<1

12

100

100

100

100

100

100

100

1

2

12

1

0

2

6

4 12 21 30 20 9

9 6 22 32 6 5

15 8 46 14 1 2

2 11 78 2 7 0

5 14 47 20 8 0

9 10 48 14 12 0

5 18 33 13 16 1

 is changes precisely the division level sampling errors are large Therefore, the are for both Years

rather than a comparison between them

 Is defined as the object or event associated the 

 and nonmetal mining, and railroads for which data are available

‘Excludes railroads

NOTE rounding, percentages may not 100.

SOURCE (608)
— ..——

percent of fatalities, but in transportation and

public utilities the figure is 52 percent. In construction, falls were responsible for a greater proportion of deaths (31 percent) than were over-theroad motor vehicles (15 percent), although industrial vehicles and equipment were associated with

17 percent of deaths.

Nearly half of all fatalities (47 percent) resulting

from falls occurred in the construction industry

(see table 4-3). Most fire- and explosion-related

Ch. 4—Safety Hazard /identification 69

————- —

deaths in the work force (46 percent) and deaths

from plant machinery (78 percent) occur in manufacturing. Additional sources of aggregate injury

statistics are described in Working Paper #l.

Aggregate statistics can guide injury prevention

by highlighting general hazard categories in specific industries. Immediate or underlying conditions related to an individual injury can only be

determined through case study.

BASIC THEORIES OF INJURY CAUSATION

Traditional Approach—Unsafe

Conditions or Unsafe Acts

In the 1920s, Heinrich proposed a theory of injury causation that many safety professionals have

followed ever since. Simplified, the theory states

a domino sequence:

• Injuries are caused by accidents.

• Accidents are caused by unsafe acts of persons or by exposure to unsafe mechanical

conditions.

• Unsafe acts and conditions are caused by

faults of persons.

● Faults of persons are created by the environment or acquired through inheritance.

Using this approach, Heinrich analyzed 12,000

cases of injury from insurance claim records plus

63,000 cases from the records of plant owners,

for a total of 75,000 cases. Seventy-three percent

of the injuries were classified as due to “unsafe

acts” by workers. Heinrich noted that 25 percent

of the cases examined would, according to the

usual methods employed at the time, have been

charged to defective or dangerous physical or mechanical conditions. However, he concluded that

many cases in this group of 25 percent were caused

either wholly or chiefly by worker failure, and

only partly by physical or mechanical conditions.

He decided to classify as “unsafe conditions” only

those cases that were wholly caused by physical

or mechanical failure. The injuries not wholly due

to physical or mechanical failure (15 percent) were

grouped with the 73 percent of cases that involved

only “’unsafe acts. ” Thus he produced a wellknown and often cited figure that 88 percent of

injuries are due to “unsafe acts” by workers (380).

Heinrich attributed only 10 percent of injuries to

unsafe conditions and considered the remaining

2 percent of injuries to be unpreventable (207).

Critique of Traditional Approach

Arndt (24) has noted that, although there has

been little research published to support Heinrich’s

theory of injury causation, Heinrich’s ratio of 88

percent unsafe acts to 10 percent unsafe conditions is commonly cited. In fact, the published research on this topic uniformly refutes Heinrich’s

theory.

Heinrich himself pointed out two other studies.

The first, by the National Safety Council (NSC),

concluded that unsafe acts contributed to 87 percent of the cases examined, while mechanical

causes contributed to 78 percent. The total of 165

percent is due to NSC’s considering multiple

causes of accidents. An analysis in 1940 by the

State of Pennsylvania showed that an “equal number” of injuries resulted from unsafe acts and mechanical causes. Heinrich recognizes the discrepancy, which he attributed largely to the fact that

the NSC and Pennsylvania studies allowed both

an unsafe act and an unsafe condition to contribute to a single injury. Heinrich’s methodology did

not permit such multiple assignment of cause

(207),
70 ● Preventing Illness and Injury in the Workplace

Table 4-4 presents a summary of other research

aimed at apportioning injury causes between unsafe acts and unsafe conditions. Heinrich’s study

is the only one to attribute more than 35 percent

of injuries primarily to unsafe acts by workers.

The other research has generally categorized most

injuries as resulting from a combination of unsafe acts and unsafe conditions.

Arndt (24) examined nearly 1,000 injuries associated with mechanical punch presses. He developed eight mutually exclusive categories to describe the circumstances of the injury. These

included operator timing errors, inadvertent tripping of the press, other operator errors, tripping

of the press by a second person, and machine

malfunctions. He found that 53 percent of the injuries resulted from something other than machine

malfunctions. All of that 53 percent would be attributed to “unsafe acts” in a dichotomous system, like Heinrich’s, for recording causes of accidents. The machine malfunctions, including

broken parts and accidental recycling of the press,

which would generally be labeled “unsafe conditions, ” amounted to 18 percent of cases. Arndt

was unable to classify 29 percent of the cases because of a lack of information.

Thus, under the traditional breakdown between

unsafe acts and unsafe conditions, about three

times as many injuries in Arndt’s study would be

classified as due to unsafe acts rather than unsafe

conditions. But Arndt observes that a very large

number of those classified as “unsafe acts” occurred on presses activated by a foot pedal, by

a one-hand control, or automatically. These

presses allow operators to insert their hands inside the “point of operation” of the press. It is not

surprising, then, that someday someone places a

hand or arm inside such a press to adjust the piece

being worked on or to clear a jam, and then is

unable to remove it quickly enough. For example, if a press operator produces 5,000 pieces a

day, then the operator’s hands are placed in front

of the press ram every 5 seconds, which means

about 25,000 times per week or 1.2 million times

a year (24). It may be only a matter of time before

an operator commits an “error” and loses a finger in the press.

There are, however, machine designs that can

reduce and nearly eliminate this particular hazard. Machines can be designed to operate with

two-handed controls, so that the operator must

have both hands on the controls. In Arndt’s analysis, 60 to 70 percent of the injuries from presses

activated by foot pedals, by one-handed controls,

or automatically were related to “unsafe acts, ” and

only 10 to 20 percent related to “unsafe conditions. ” For presses with two-handed controls, the

fraction due to “unsafe acts” was only 35 percent.

“Unsafe conditions” were cited in about 54 percent of these cases. Arndt’s paper does not present any information on the injury rates associated with the various kinds of presses because data

on the total numbers of each control type are not

available. But it is clear that the design of the press

has a dramatic affect on the number and percentage of cases attributed to “unsafe acts. ”

The traditional partition between unsafe acts

and unsafe conditions unfortunately often draws

Table 4-4.—Estimated Percentages of Accidents Due to

Unsafe Acts versus Unsafe Conditions

. .——

Percent due to Percent due to Percent due to ‘Percent -

—.

Study unsafe acts unsafe conditions combination unknown

Furniss . . .:. . . . . . . ~. . . . . . . — –

16 84- —

Pennsylvania Department of

Labor. . . . . . . . . . . . . . . . . . . . 2 3 95 —

National Safety Council. . . . . . 19 18 63

Mintz and Blum . . . . . . . . . . . . .

—

21 — 79

Hagglund a . . . . . . . . . . . . . . .

—

26 58 2 13

Hagglund b . . . . . . . . . . . . . . . . . 35 54 4 7

Henrich c . . . . . . . . . . . . . . . . . . . 88 10 — — —— — —

alnvestigations of reported fatalities.

bRandom sample of accident reports

cHenrlc h classified 2 percent as ‘unpreventable ‘‘

SOURCES (30,37,207,316)
Ch. 4—Safety Hazard Identification 71

attention away from the job or equipment redesigns that can remove or minimize hazards. In the

1959 edition of his textbook, Heinrich himself cautioned safety professionals not to neglect workplace conditions. He expressed confidence that

safety professionals would not “ignore the very

first common-sense step. . . of safeguarding [the]

mechanical environment” (quoted in 462).

The catchall category of “unsafe act” or “human

error” has greatly restricted advances in injury research and the application of control techniques

in workplaces (380). The label “unsafe act” has,

unfortunately, often led to a failure to recognize

how the design of workplace equipment can minimize the occurence of “unsafe acts” or reduce the

probability and severity of human injury.

The seriousness of this limitation is clear from

one commonly used system for recording information about injuries. The American National

Standards Institute (ANSI) Standard Z16.2,

Method of Recording Basic Facts Relating to the

Nature and Occurrence of Work Injuries, used

widely for employer injury investigation and recordkeeping. ANSI itself sees inadequacies in its

method, as the text of Z16.2 indicates:

It is recognized that the occurrence of an injury

frequently is the culmination of a sequence of

related events, and that a variety of conditions

or circumstances may contribute to the occurrence

of a single accident. A record of all these items

unquestionably would be useful to the accident

preventionist.

Any attempt to include all subsidiary or related

facts about each accident in the statistical record,

however, would complicate the procedure to the

point of impracticability. The procedure, therefore, provides for recording of one pertinent fact

about each accident in each of the specific categories or classifications. To insure uniformity in

the selection of items to be recorded in each category, the items are specifically defined in terms

which eliminate any necessity for decision as to

the relative importance of multiple items falling

in the same category (emphasis added).

Instead of collecting information on all the circumstances leading to the accident, the ANSI

Standard Z16 allows “only one pertinent fact” to

be recorded concerning the nature of the injury,

the source of the injury, the type of accident, the

hazardous condition present, and any unsafe act.

This standard facilitates the administration of injury data collection because of its simplicity, but

it is inadequate for research on causation. Unfortunately, the most common entry under this system is simply to attribute the injury to “worker

error. ”

According to Purswell and Stephens (380), attributing responsibility for accidents to human error, with no significant information as to why the

error was committed, is not limited to the ANSI

system. It is found in other workplace-injury data

collection systems as well as those for collecting

data on non-workplace injuries. For example, researchers in the field of highway safety have noted

that there is no place on standard police forms

to record many items that relate to features of the

vehicle or the road that contributed to the injury.

For the most part, these forms are oriented around

recording information on the driver (41).

OTHER MODELS OF INJURY CAUSATION

Purswell and Stephens (380) describe a number of other models of injury causation and investigation. These include behavioral models,

management models, epidemiological models, and

ergonomic or human factors models.

Behavioral Models

The underlying concept of behavioral models

is that of the “accident proneness” of individuals.

Some safety specialists believe that a disproportionate number of injuries are incurred by a handful of individuals who are especially prone to accidents. Accident proneness has been, at one time

or another, ascribed to recent immigrants to the

United States, to certain ethnic/racial groups, or

to certain personality traits (380). Thus efforts

were made to identify these workers and either

fire them or not hire them in the first place. Later

researchers have been unable to find similar traits
72 . Preventing Illness and Injury in the Workplace

that will reliably predict which workers will be

injured. Unfortunately, the belief that there are

“injury-prone” workers is still commonly held.

According to a Bureau of National Affairs (78)

report, 65 percent of the businesses surveyed

stated that their safety programs attempted to

identify “accident-prone” individuals.

Other behavioral models have considered motivational factors, the rewards of working safely,

and the level of satisfaction received from working safely (368). It has been observed that many

workers perceive little positive reward for

working safely.

Management Models

Bird (58) revised Heinrich’s domino theory to

emphasize management’s responsibility for injury

causation. His revised domino theory is:

●

●

●

●

Injuries are caused by accidents.

For each accident there are immediate causes

that are symptomatic of problems in the

overall system.

There are basic causes in the overall management of the system that produce the immediate causes of the accident.

The lack of management control permits the

basic causes of accidents to exist in the

system.

Bird’s approach therefore shifted the emphasis

from the worker as the cause of injuries to the

management system in which the worker exists.

Zabetakis (684) of the Mine Safety and Health

Administration Academy added the idea that injuries are due to an unplanned release or flow of

energy, again following the approach of the domino theory. Energy release is considered in the

general sense—mechanical, electrical, chemical,

thermal, or ionizing radiation. Since unwanted

energy flow is a fundamental source of injuries,

Zabetakis claimed, a system maybe evaluated and

improved by studying:

the sources of energy existing in a system,

the means available to reduce the energy

levels,

the means of controlling the flow of the

energy, and

the methods available for absorbing the

energy should loss of control or improper

flow occur.

The next major outgrowth of the domino theory was based on the idea that multiple factors

can combine in a random manner to produce accidents and injuries. Such causation models focus

not only on unsafe acts of the injured person, but

also on unsafe acts of coworkers and unsafe conditions that existed at the time. Attention is

ultimately drawn to failures in management systems that permit the multiple factors to converge

and produce an injury.

One of the best known management-oriented

approaches to accident causation is called the

Management Oversight and Risk Tree (MORT),

developed by Johnson (235) for use in the analysis of complex systems related to atomic energy.

It could also be called a systems model (discussed

later in this section). MORT employs a large schematic to inductively trace events of a work-related

injury back in time, to identify the sequence of

unwanted energy flow, and to evaluate the adequacy of barriers to unwanted energy transfer to

persons or equipment. Along the route, hazards

arising from specific accident circumstances, from

risks acknowledged or assumed by management,

and from general management systems and policy weaknesses are identified.

Still, several difficulties exist in adopting MORT

to general injury investigation or applying it to

most industrial workplaces. Its use as an industrial injury investigation procedure is limited by

its complexity. The method is more suitable for

investigating large-scale incidents, especially situations holding the potential for public disaster,

such as nuclear powerplants. While it is an excellent approach for these situations, in its present

form it is much less useful for explaining most

work-related injuries. But it may be useful as a

blueprint for the optimal allocation of resources

for building a safety program (380).

Epidemiologic Models

Epidemiology has been described as the search

for causal association between diseases or other

biologic processes and specific environmental experiences or exposures. The epidemiologic model

applied to injury research seeks to explain the
occurrence of injuries within the system of host

(injured victim), agent (means of injury), and the

environment (physical, psychological, and social

factors related to the event).

Using such a model, it should be possible to

identify features common to a set of injuries or

accidents, and either identify causes directly or

find clues to causation. This approach has advantages over investigating each incident separately,

Looking at a group of off-the-road industrial vehicle accidents, for instance, it might become apparent that one company’s products are involved in

a disproportionate number of incidents (40).

Gordon (187) and McFarland (295) were two

early proponents of epidemiologic models of injury causation. Haddon (197) was successful in

implementing an epidemiologic approach to transportation accidents while directing the National

Highway Traffic Safety Administration. Baker

and her coworkers (40) have successfully used epidemiologic techniques to describe work-related

deaths in Maryland.

The epidemiologic method requires the collection and study of far more information about the

host, the environment, and their interactions than

the behavioral and management models do. This

approach, which recognizes the interactive nature

of the injury process, is a significant advance over

earlier models. In fact, it has provided a framework for the application of many systems approaches that incorporate human operator variables, environmental factors, and task demands.

The National Institute for Occupational Safety

and Health is currently conducting two epidemiologic studies to evaluate the role of personal,

managerial, and work environment factors in the

etiologies of fall-from-ladder accidents and accidents that result in fatal injuries. Both are casecomparison studies that should produce a scientific assessment of these causal factors.

Systems Models

The emergence of systems engineering as a discipline in the 1960s gave rise to many new applications of systems theory, including systems safety.

The various models that have been used include

“failure mode and effects analysis” and “criticality

analysis.” Both these are largely oriented towards

Ch. 4—Safety Hazard Identification ● 73

assessing the reliability of hardware and equipment. Another systems model, “fault tree analysis, “ involves building a logical “tree” of events

that can lead to undesirable outcomes. The ana- ●

lyst examines component failures, which can include both hardware and human errors, and attempts to learn what might cause these failures

and what effects on system safety they might

have.

The systems-safety models have been applied

most extensively in military and aerospace endeavors with the focus on potential failure points

in system hardware. Few quantitative data exist

about human error rates, so including the human

component of this system is frequently precluded.

Ergonomic/Human Factors Models

The injury causation models developed by

human-factors engineers or ergonomists attempt

to provide insights into the problems of “unsafe

acts” or human error that are lacking in other injury causation models.

Ergonomists generally analyze the interactions

between workers and their machines for the

sources of injury causation. The limits of human

beings to perform consistently and without errors

are important issues to the ergonomists. Rather

than viewing operators’ errors as merely “unsafe

acts” that can only be addressed through training and motivation, the ergonomic approach

looks to see if various features of the machine or

the design of the work might themselves be inducing worker errors. These features can include

the presentation of information to workers

through displays, the design of machine controls,

and the relationships between displays and controls. In addition, ergonomists analyze the physical capacities of workers, such as lifting or

reaching ability, to determine whether the task

places undue stress on specified parts of the body

or leads to excessive fatigue.

Because of the importance of this discipline for

the prevention of both acute trauma and cumulative trauma, as well as its potential usefulness

in the field of general workplace and equipment

design, ergonomics is discussed in greater detail

in chapter 7.
74 ● Preventing Illness and Injury in the Workplace

CRITIQUE OF INJURY CAUSATION THEORIES AND MODELS

The inherent simplicity of Heinrich’s domino

theory and its historical availability no doubt account for its widespread acceptance. A minimum

amount of training is required to understand its

application and it does provide an answer to the

question of “cause,” even if it is a superficial one.

Since most injuries are classified as resulting from

“unsafe acts, “ it unfortunately allows more fundamental features of workplace design that lead

to injuries to be ignored.

Behavioral models initially contributed to our

understanding of the human component of injury

causation, although approaches based on studying “accident proneness” have contributed little

or no useful information for prevention. It is unfortunate that many firms still expend resources

trying to identify “accident-prone” individuals,

rather than pinpointing features of workplace design that lead to injuries.

The adaptations of Heinrich’s theory that place

the responsibility for unsafe acts and unsafe conditions on the management system of the enterprise represent a major step forward in preventing occupational injuries, The causal explanations

are still too simplistic, although these approaches

do provide a limited ability to predict the occurrence of hazards in the workplace.

The chain-of-events or multiple events models

(MORT is an example) recognize that many factors influence injury causation and thus represent

progress over single-event models. However, the

current models do not have a sufficiently simple

organizing structure to make them useful across

a wide range of industries.

The epidemiologic model has value as an organizing framework for the systematic study of the

factors related to various types of injuries. It is

limited in that, in general, it cannot adequately

explain why injuries happen or how corrective

measures can be identified and applied.

The systems models have been developed primarily to evaluate system, subsystem, and component failures. The primary focus has been on

nonhuman or hardware failures. Although the potential exists for incorporating human error rates

into these analyses, the data to do so are currently

very limited.

The human factors/ergonomics models focus

on the human/machine interface and thus provide a much-needed emphasis on understanding

the interaction of worker and machine in order

to achieve a safe working environment. The thrust

of the practice of ergonomics is designing the work

tusk, rather than merely installing machinery and

letting the worker find a way to adapt. Thus injury prevention can bean integral part of job design. The principal shortcoming of this model is

the absence of any analysis of hardware failures

beyond the human/machine interface. However,

compared with the injuries that occur at that interface, hardware failures are relatively rare.

Purswell and Stephens (380) conclude that no

single model provides a wholly satisfactory approach to explaining the various facets of injury

causation. They suggest that, for the present, the

epidemiologic model is useful for identifying major categories of causal factors in the workplace,

and that these major categories should be studied in-depth using the human factors/ergonomics

model.

The quest for causal models should not be the

sole object of research on injury prevention. What

is even more important is the design of interventions to eliminate or reduce the injury hazards

faced by workers. In fact, one distinguished researcher has concluded that the search for causal

models for injuries may ultimately be fruitless.

Singleton has recently stated that “there can never

be a theory which will predict an accident and

even accident rates are subject to too many

variables for prediction to be meaningful. ” But

he adds:

It does not follow that we must abandon hope

of controlling accidents. The same problem occurs in other complex practical situations. The

physician, for example, is often faced with a patient with a disease which he cannot readily identify. . . However, this does not mean that nothing

can be done, The physician has certain general

principles; the temperature must not be allowed

to get too high, the body must not get dehydrated

and so on. He can take action on the basis of these

principles without waiting to identify the cause

of the symptoms. Similarly in accident prevention we can take action to increase safety without waiting for a theory of accident causation

(442).
Technologies for Controlling

Work-Related Illness

.
Contents

Page

Control Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78

Control at the Source . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80

Controlling Dispersion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82

Control at the Worker.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

Integration of Health Hazard Controls into Workplace Management . . . . . . . 85

Case Study: Controlling Worker Exposure to Cotton Dust . . . . . . . . . . . . . . . . . . 85

Byssinosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85

The OSHA Cotton Dust Standard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86

Changes in Cotton Dust Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86

Costs of Compliance with the Cotton Dust Standard . . . . . . . . . . . . . . . . . . . . . 88

Case Study: Controlling Worker Exposure to Silica Dust. . . . . . . . . . . . . . . . . . . . 89

R,gulatory Activities for Silicosis Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90

Control Technologies: Engineering Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90

Control Technologies: Personal Protection and Administrative Controls . . . . 91

Strategies for Silica Dust Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91

Case Study: Controlling Worker Exposure to Lead . . . . . . . . . . . . . . . . . . . . . . . . . 92

Some Features of the OSHA Lead Standard .......,. . . . . . . . . . . . . . . . . . . . 9 2

Control Methods: Engineering and Respirators. . . . . . . . . . . . . . . . . . . . . . . . . . . 93

Medical Removal Protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

Changes in Air Lead Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94

Changes in Blood Lead Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95

Costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96

Summary of Improvements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96

Extent of Control Technology Usage in the United States . . . . . . . . . . . . . . . . . . . 97

Information About Controls and Areas for Research . . . . . . . . . . . . . . . . . . . . 97

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99

LIST OF TABLES

Table No. Page

5-1,

5-2,

5-3.

5-4.

5-5.

5-6.

5-7.

5-8.

5-9.

5-10.

5-11.

Principles of Controlling the Occupational Environment . . . . . . . . . . . . . . . 80

Benefits of New Technologies for Controlling Worker Exposure to

Vinyl Chloride Monomer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

Suggested and Recommended Levels for Cotton Dust Exposure . . . . . . . . . 88

Cotton Dust Measurements Before Promulgation of the OSHA

Cotton Dust Standard and Percentage of Companies Claiming Compliance

with the Standard in North Carolina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88

Estimated and Realized Costs of Compliance with the OSHA

Cotton Dust Standard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

Measures To Reduce Air Lead and Blood Lead Levels . . . . . . . . . . . . . . . . . 93

Blood Lead Levels That Trigger Medical Removal From and Return to

Lead-Contaminated Atmospheres. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

Medical Removal Protection Transfers in a Sample of

Lead Industry Plants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94

Reductions in Average Air Lead Levels, 1977-78 and 1981-82. . . . . . . . . . . 95

Average Blood Levels Before and After Promulgation of the OSHA

Lead Standard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95

Projected Industry-Wide Annual Costs of Compliance With Air Lead

Levels of 50 to 150 micrograms/m3 . . . . . . . . . . :. . . . . . . . . . . . . . . . . . . . . . 96 ,

LIST OF FIGURES

Figure No. Page

5-1. Generalized Occupational Exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

5-2. Generalized Model for Control of Workplace Hazards . . . . . . . . . . . . . . . . . . 78

S-3. Vinyl Chloride Reactor System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
5.

Technologies for Controlling

Work-Related Illness

This chapter describes the principles and technologies for controlling workplace health hazards—toxic substances and harmful physical

agents found in the workplace. For clarity and

since the control principles are similar for both

toxic substances and harmful physical agents, discussion focuses on control of the former. Emphasis is given to technologies proven to be the most

effective for protecting workers’ health—those

that prevent hazard generation or that prevent

worker contact with the hazard. Three case studies commissioned by OTA illustrate these principles and technologies as applied in controlling

work-related exposure to cotton dust, silica, and

lead. In addition, the extent of the use of control

technologies in United States workplaces is discussed.

Health hazards, as defined by public health science, cause disease by an agent (hazard source)

transmitted through the environment by a vector (transmission of hazard) to a host or a receptor (worker) who is affected. This model includes

workplace hazards to which workers are exposed

(see fig. 5-1). For workplace hazards, the source–

the point at which the hazard is generated—may

be a gas, a liquid, or a solid if it is a substance,

or a form of energy if it is a physical agent. Transmission or dispersion of the toxic substance or

harmful physical agent is generally through workplace air or by direct contact. The worker at risk

may receive (absorb) the hazard through ingestion, the skin, or by inhalation (see fig. 5-2).

A control technology system can include hazard

control at any or all of these three points—source,

transmission, or worker. Hazard controls applied

at the source, such as isolation of a process, or

in the transmission or dispersion path, such as

local exhaust ventilation, are generally called

“engineering controls. ” Those worn by the workFigure 5-1 .—Generalized Occupational Exposure

~

Source Workplace Worker

Generation Transfer Exposure

—Gas — Respiratory

— Liquid — Dermal

—Solid — Ingestion

— Energy

er, such as protective clothing or a respirator, are

generally called “personal protective equipment.“

A hierarchy of control methods is commonly

used. The first choice is control at the source,

which can be done by design or modification of

a process or equipment or by substitution of less

hazardous materials. If the source is unalterable

through design or substitution, the next choice is

to control or contain the dispersion of the contaminant by isolation of the source, preventing

the toxic substance from becoming airborne, or

by removing the contaminant through local exhaust or general dilution ventilation. Finally, control at the worker may include administrative controls, personal protective equipment, and work

practices. (Personal protective equipment is discussed in ch. 8, and the hierarchy of controls is

discussed in ch. 9.)

77
78 ● Preventing Illness and Injury in the Workplace

Figure 5-2.—Generalized Model for Control of Workplace Hazards

Zone I

source

Production process

CONTROL SYSTEMS

There have been many attempts to define control technology. Brandt (71) described it as a system designed to control contaminant emission and

dispersion along the pathway to the worker.

Bloomfield (61) cited ventilation to reduce levels

of airborne contaminants as the primary means

of engineering control. The International Labour

Office (229) includes several techniques in control technology: ventilation; process changes; substitution of process, equipment, or material; isolation of stored material, equipment, process, and

workers; and education of management, engineers, supervisors, and workers. Caplan (96)

defined engineering controls for industrial hygiene

purposes as “installation of equipment, or other

physical facilities, including if necessary selection

and arrangement of process equipment, that significantly reduces personal exposure to occupational hazards.” Smith (450) defined control technology as substituting less dangerous substances,

equipment, or processes; limiting releases or preventing buildup of environmental contamination;

Zone Ill

receptor

Photo credit: NIOSH

This electrostatic precipitator is used to remove oil

mists from the atmosphere of a machine shop

limiting contacts between worker and toxic materials by personal protective equipment; and introducing administrative changes.
Ch. 5—Technologies for Controlling Work-Related Illness ● 7 9

For this assessment, a hazard control system includes:

1. control at the emission source by substitution of materials, change of process or equipment, or other engineering means,

2. control of the transmission or dispersion of

the contaminant by isolation, enclosure, ventilation, or other engineering means, and

3. control at the worker by personal protective

equipment, work practices, administrative

control, training, or other means.

The controls in No, 1 and No. 2 are commonly

called “engineering controls. ”

Training workers, supervisors, managers, engineers, and other concerned persons about a hazard and its control underlies the effectiveness of

control solutions. Hazard-free operation requires

rigorous maintenance of controls, and good

housekeeping is essential to control secondary

sources of contamination. Work practices (e.g.,

instructions that liquids should be poured away

from the worker) and administrative procedures

(e.g., that workers spend limited time in the presence of hazards) are also important parts of a control system. Table 5-1 is a compilation of hazard

control principles and includes examples of control measures.

One tenet of effective hazard control is that a

system should be designed in a way that the controls are automated or inherent in the operation

of the system. Thus, hazard controls should function even in the absence of continuous worker and

manager attention. For instance, enclosing a process to prevent emission of toxic substances to

workplace air is a more reliable, and likely less

expensive, control than respirators, where effectiveness is difficult to measure, protective fit is

difficult to achieve. Although systematic design

will consider a variety of control methods and

combinations, engineering solutions are preferred

because they depend less on routine human involvement for effectiveness. For example, grounding home electrical appliances provides greater

protection against electrical shock than instructions to remember not to simultaneously touch

an ungrounded appliance and a metal surface.

Photo credif: OSHA, Office Of Informatlon and Consumer Affairs

Engineering controls include the enclosure of

operations and using remote controls. This photo

illustrates equipment designed to handle very toxic

radioactive materials

Because of the continuing need for human intervention and attention in the use of personal

protective equipment, practicing industrial hygienists employed by business, government, and

unions have long recognized that such equipment

should be turned to only after other means of protection have been exhausted (see ch. 9). Occupational Safety and Health Administration (OSHA)

standards require the use of engineering and work

practice controls except for the time period necessary to install such controls, when engineering

and work practice controls are infeasible (including many repair and maintenance activities),
80 . Preventing Illness and Injury in the Workplace

Table 5=1 .–Principles of Controlling the

Occupational Environment

Point of application of

the control measure Control measure

At or near the hazard

zone. . . . . . . . . . . . . . . . . .

To the general workplace

environment . . . . . . . . . . .

At or near the worker . . . . .

Adjuncts to the above

controls . . . . . . . . . . . . . . .

Substitution of

nonhazardous or less

hazardous material

Process modification

Equipment modification

Isolation of the source

Local exhaust ventilation

Work practices

(housekeeping)

General dilution ventilation

Local room air cleaning

device

Work practices

(housekeeping)

Work practices

(housekeeping)

Isolation of workers

Personal protective

equipment

Process monitoring

systems

Workplace monitoring

systems

Education of workers and

management

Surveillance and

maintenance of controls

Effective process-people

interaction and feedback

SOURCE (576)

when they are insufficient, and in emergencies (see

ch. 9). For instance, engineering solutions to reduce airborne lead concentrations to the OSHA

standard are difficult to apply in lead smelters,

and OSHA allows respirator programs while the

solutions are engineered.

Of course, the nature of some jobs requires reliance on personal protective equipment. For instance, firefighters depend on self-contained

breathing apparatus when fighting fires.

Control at the Source

Control at the source can be achieved by design of new or modification of existing processes

or equipment, or by the substitution of less hazardous materials-all done, preferably, before the

process or equipment is installed and operated.

The industrial hygiene literature repeatedly points

to source control as the most effective means of

preventing work-related illness.

Designing Controls

Designing equipment to eliminate contact between hazard and worker is the most effective way

to control exposure (71). The control of vinyl

chloride monomer (VCM) provides an example

of successful design eliminating a health hazard

(see also box N in ch. 12). In the 1960s, before

VCM was recognized as a carcinogen, it was identified as a cause of acro-osteolysis (bone deterioration, especially in the finger tips). This finding led

the American Conference of Governmental Industrial Hygienists (ACGIH) to revise the Threshold

Limit Value (TLV) exposure limit from 500 parts

per million (ppm) to 200 ppm in 1970 (5).

Revision of the exposure limit meant that the

firms that followed ACGIH recommendations had

to find ways to reduce worker exposure. Analysis by design engineers identified two methods by

which the high exposures associated with cleaning the VC reactor vessel could be reduced: elimination of reactor fouling or mechanical or chemical removal of the polymer buildup. Hydraulic

reactor cleaning technology was adopted that reduced the frequency of worker cleaning from once

per several reactor charges (loading the reactor)

to once per 25 to 30 charges and thereby reduced

worker exposure (256).

When VCM exposure was recognized in 1974

as strongly related to angiosarcoma of the liver

(a rare and deadly cancer) by health professionals,

OSHA mandated a permissible exposure limit of

1 ppm. Feasible engineering and work practice

controls were required to reduce exposure below

this level (617).

Again, industrial hygiene analysis determined

that exposure to gases during reactor cleaning was

a major problem. Re-investigation led the design

engineers back to earlier considerations, of either

eliminating the fouling or finding an automated

cleaning method. But this time the design criterion

was to reduce drastically exposure from over 200

ppm down to 1 ppm, and mechanical cleaning

alone was found to be inadequate. However,
Ch. 5—Technologies for Controlling Work-Related Illness ● 8 1

spraying a simple coating solution on interior reactor walls before mixing each batch prevented

polymer buildup, Automating and enclosing the

reactor cleaning process by installing a permanently mounted nozzle inside the reactor (see fig. S3) very effectively contained the VCM gases and

greatly reduced worker exposure (256).

Commercial use of this design demonstrated

that the new reaction vessels needed cleaning only

once every 500+ polymerization batches, greatly

improving the productivity of the process. The

developer, B.F. Goodrich, now uses the innovative process in its vinyl chloride monomer plants

both here and abroad and also licenses it worldwide to other chemical manufacturers. Table 5-2

shows the benefits of this control technology

(256).

This example illustrates the advantages of applying engineering controls to the prevention of

work-related illness. Engineers sought solutions

to a recognized health problem by first considering methods that would eliminate exposure such

as by automating cleaning or by preventing buildup of materials that require removal. This example also shows that production costs can be reduced and productivity increased, as Brandt

postulated some 35 years ago in his book on occupational health engineering (71).

Health hazards can also be eliminated or controlled by changing an industrial process. For example, the National Institute for Occupational

Safety and Health (NIOSH) recently conducted

a study of dry cleaning machine operators exposed

to perchloroethylene, a widely used solvent,

known to cause contact dermatitis, central nervous system depression, liver damage, and anesthetic death. NIOSH investigators found higher

exposure levels of perchloroethylene vapors in

processes involving separate washing and drying

machines than in processes that combined these

two steps in one machine. The two-step process

requires manual transfer of clothes, resulting in

unnecessary worker exposure, which is avoided

in the combined process.

Substitution

Substitution of a less toxic agent for a more

toxic one is an important means of control, but

care must be taken that the substitute does not

Figure 5-3.-Vinyl Chloride Reactor System

Coating

solution

tank

Coating Water

solution

Internal

 flush

nozzle

Reactor

I

I

Table 5-2.—Benefits of New Technologies for

Controlling Worker Exposure to

Vinyl Chloride Monomer (VCM)

Reduction in worker exposure to VCM.

Reduction in VCM emissions to the atmosphere.

Closed reactor operation—entry only for normal

maintenance.

Savings in labor.

Reduction in reactor downtime due to cleaning and, as a

result, increase in productivity.

Polymer buildup lost as scrap is eliminated.

Reduction of rupture disc changes due to polymer

buildup.

Constant and maximum process side heat transfer

coefficient in the reactor.

SOURCE: (25S).

itself harbor toxic properties. For example, asbestos, an excellent insulator, is found widely in

buildings, ships, and other places requiring thermal insulation. However, as its toxic properties,

especially its carcinogenicity, were recognized,

other materials were considered as a replacement.

Several materials are suitable, depending on the

application and the temperature range to be insulated. These include insulating concrete, vermiculite, fiberglass, and rockwool. While none

of these is yet known to cause cancer, precautions
82 ● Preventing Illness and Injury in the Workplace

should be taken to control exposure to these

materials during installation (80).

Silica dust, which can cause lung disease, is one

of the oldest known occupational health hazards,

and its control well illustrates the principle of substitution (see case study, later in this chapter).

Silica dust is a problem in “sand blasting, ” in

cleaning and polishing moldings and metals, and

in mining and quarrying, where it is generated by

explosives and mining machinery.

In foundries, silica dust is generated during

cleaning, during chipping and grinding of castings

because some sand from the cores and molds remains on the castings, and during abrasive cleaning, which generates airborne silica dust. If

abrasive cleaning is performed by sand blasting,

silica dust may be generated from both the blast

sand and the mold and core sand.

The most direct method of eliminating silica

dust is to make substitutions for silica-containing

material. A number of silica-sand substitutes are

available for abrasive blasting, including metallic

shot and grit, garnet, nut shells, cereal husks, and

sawdust, and have been widely used in abrasive

blasting operations and to some extent in foundries (560).

In some cases, silica dust can be eliminated by

substitution of a nonabrasive process—by cleaning castings by the salt bath process, acid pickling, or ultrasonic cleaning. Water jetting and laser cutting to remove excess metal from castings

have been considered as alternatives to chipping

and grinding (435).

Controlling Dispersion

If a source cannot be altered through design or

substitution, the next choice is to control or contain the dispersion of the contaminant. This may

be done by isolating the source, preventing the

toxic material from becoming airborne, or by ventilation.

Isolation

Isolation of a process involves the placement

of a barrier between the process and the worker.

In dusty operations for example, there are three

basic means of isolation: enclosure of an operation (to prevent dust, fumes, or vapors from

escaping into occupied areas); automation,

through the use of unattended machines; and distance, to place operations away from workers.

Isolation by enclosure has been used effectively

to reduce silica exposure in foundries (359,569,

577). Abrasive blasting operations maybe located

in enclosed, ventilated booths. Enclosure is also

used to reduce worker exposure in the asbestos

textile industry. Card machines, among the dustiest parts of the asbestos textile manufacture process, can be completely enclosed and asbestos dust

filtered from the air exhausted (80). Enclosure has

been applied successfully in containing contamination from radioisotopes since the beginning of the

nuclear industry. A variation is to protect workers from physical and chemical hazards by locating their work stations in ventilated control

booths.

Many jobs with risk of exposure to toxic substances can be automated. For instance shakeout

(a method for removing foundry sand from molds

or parts) in a foundry can be done by ventilated

machines rather than by hand. Automobiles may

be spray painted or welded by automated machines to remove workers from exposure to spray

paint and solvent and welding fumes, respectively.

Finally, explosive or extremely toxic materials

can be stored in remote and inaccessible areas and

hazard-generating operations may be removed

from areas where workers are concentrated.

Open-air sand blasting can be done at a distance

from other work sites to reduce the number of

workers at potential risk. Persistently leaky

pumps and piping for the transport of toxic substances can be isolated by placing them in areas

remote from workers.

Wetting

Wetting dust to prevent it from becoming airborne is used to reduce worker exposure. Spraying is a primary means of dust control in mining,

but it is considered to be inadequate alone and

is usually used in conjunction with ventilation

(230,394). Substitution of wet processing and

spraying for dry operations has been widely used

to control silica dust. In foundries, adding moisture to sand has been found to reduce dust con-
Ch. 5—Technologies for Controlling Work-Related illness ● 8.3

centrations substantially (435,569). By contrast,

wet processing in the manufacture of portland cement appeared to have no effect on respirable dust

levels (419).

Local Exhaust Ventilation

Local exhaust ventilation is one of the most

commonly used engineering controls. It aims to

protect the worker by capturing generated gases,

vapors, fumes, or particles in an exhaust air

stream and discharging them away from workers. Examples are laboratory fume and kitchenrange hoods, both of which use fans to exhaust

contaminated air, Industrial operations are often

placed in hoods to obtain maximum contaminant

control with minimal exhaust air volume.

For example, local exhaust can be applied in

aluminum reduction operations to reduce worker

exposure to carcinogenic particulate, in spray

paint booths to control paint mist and solvent

vapors, in garages to control carbon monoxide

from auto exhaust, and in foundries to control

silica exposure from abrasive blasting and grinding.

NIOSH is currently investigating “push-pull”

ventilation. Generally, local exhaust ventilation

depends on “pulling” air away from the operation and exhausting it at some distance from the

worker, If the emission source is over two feet

from the exhaust, a great quantity of room air

must be pulled into the exhaust, significantly reThis hood in a secondary lead smelter illustrates the

use of local exhaust ventilation

ducing control effectiveness. Furthermore, energy

costs are increased to heat the air that replaces

the exhausted air.

Using a jet of air “upwind” from the exhaust

pushs the emissions toward the exhaust. This is

commonly referred to as push-pull ventilation.

NIOSH showed that push-pull ventilation controlled emissions from chrome plating tanks with

just 25 percent of the exhaust needed if only pull

was used. The system thus controlled emissions

and reduced energy costs (582).

A successful local exhaust ventilation system.—As already indicated, controlling exposures

is best done by considering design of the health

hazard control at the time a process is established

and carefully monitoring performance of the system. Anderson (20) describes the effective design

of a control system in a large electronics plant.

The process begins when a manufacturing engineer asks to add or change a chemical process.

The request is submitted to the facilities engineering department and an engineer is assigned responsibility for installing the equipment to satisfy

process, safety, health, and other requirements.

Part of the facilities engineer’s responsibility is to

review the need for local exhaust ventilation with

the industrial hygienist, who is responsible for providing health protection information including details about hood design and air volume requirements. The preliminary design is then reviewed

by the environmental engineering department to

determine the need for air cleaning devices and

emission permits. After the process design is

completed, it is given a final review by the industrial hygiene, environmental engineering, safety,

maintenance, and manufacturing engineering departments.

Installation is supervised by a coordinator who

ensures that contract specifications are followed,

Changes must be approved by the facilities engineer. The contract coordinator informs the facilities engineer when the job is done and puts a

warning tag on each completed hood.

Before the hood can be used it must be adjusted

to meet design specifications by the facilities engineer and the maintenance ventilation technician,

who enters information about the system in a data
84 . Preventing Illness and Injury in the Workplace

base for scheduling preventive maintenance and the gradual introduction and mixing of fresh air

who also tags the hood to indicate that this has with, and exhausting of, workplace air. Conbeen done. After this the hood is inspected by the tinuous air exchange in buildings reduces nonindustrial hygienist, who reviews its use with the taminants that resist other control means while

workers and ensures that the proper chemical contributing to maintenance of a comfortable enidentification labels are placed at each station. vironment. General dilution ventilation is defined

Hood effectiveness is measured periodically and

data entered into a computer. Each week the computer system generates a card for each hood performing below specified levels for review by the

industrial hygienist. If the hood is in need of attention, the card is forwarded to building maintenance. If that department is unable to fix the

hood, the facilities engineering department treats

the failure as a unique project, and then follows

the same procedure that is used in designing a new

hood,

If a hood is found to be dangerously deficient

by the ventilation technician, it is tagged “Do Not

Operate” and immediately reported to the department manager, facilities engineering department,

and industrial hygiene department.

The main features of this well-thought-out system for designing and managing controls are:

● coordination among all concerned parties,

. integration of occupational health concerns

at the beginning and throughout the design

process,

. integration of occupational health concerns

following installation, and

● execution of a well-planned preventive maintenance program.

The company has found that this approach

greatly lowers costs by reducing the need to

retrofit processes. Before this method was

adopted, newly installed exhaust systems frequently failed because of improper design or installation. Post-installation approval guarantees

all concerned parties that the system works from

the start as it was designed. A well-planned,

computer-based, preventive maintenance program assures continued effectiveness.

General Dilution Ventilation

as “the process of supplying or removing air by

natural or mechanical means, to or from any

space” (71). The air circulation systems found in

most buildings are examples of general dilution

ventilation.

This technique requires careful planning, and

it can fail if inadequate consideration is paid to

contaminant generation rates. Furthermore, provision must by made for adequate fresh “makeup”

or “replacement” air, for heating or cooling the

makeup air, and for avoiding contamination of

makeup air.

Recent interest in energy conservation has

added new considerations. Increased building insulation has greatly reduced the flow of air from

“leaks,” which requires more makeup air. Chapter 16 describes particular problems among office

workers in new “tighter” buildings, Office workers report health effects from microorganisms,

organic chemicals, asbestos, tobacco smoke, and

other sources in buildings with inadequate ventilation (25).

Control by general ventilation is aided by

removing sources, such as smoking, and by cleaning air. Since most building ventilation systems

now recirculate air, cleaning the air becomes especially important. This is a relatively new problem; before energy conservation was given emphasis, accepted engineering practice was to

completely exchange building air to avoid contamination buildup. Now, building air is often

cleaned and then recirculated to reduce energy

cost. Systems are available for cleaning both gas

and particulate, but care must be taken to ensure

that the system is reliable and the cleaning complete (563).

Neither local nor general ventilation acts to prevent generation of hazards; it can only capture

or dilute contaminated air and take it to another

location. The air may still have to be cleaned

While local exhaust systems are applied at a before discharge to the ambient environment, to

particular point to remove contaminants at rela- meet Environmental Protection Agency or other

tively high rates, general dilution ventilation is ambient-air standards (6,562,563).
Ch 5- Technologles for Controlling Work-Related Illness ● 8 5

CASE STUDY:

CONTROLLING WORKER EXPOSURE TO COTTON DUST
86 . Preventing Illness and Injury in the Workplace

—

The quote was made in reference to a respiratory disease suffered by workers in English- textile mills 150 years ago. That disease—byssinosis,

or “brown lung’’—was recognized in this country

much later than in Europe. The reasons for the

late recognition are complex. Many occupational

health authorities suggest ignorance or refusal to

recognize particular respiratory diseases that were

common to mill workers to spare employers the

costs of installing controls. In addition, social conditions inhibited workers from making their complaints known and prevented actions on those

complaints. Also, local and State Governments

were reluctant to act because they feared the loss

of textile industry jobs as a result of requiring prevention of work-related injury and illness. Finally,

a lack of scientific studies showing an association

between cotton dust and illness in the United

States contributed to the tardy recognition of the

disease and inhibited action to prevent it until

OSHA came into being (124).

The OSHA Cotton Dust Standard

Although the exact disease-causing agent within cotton dust has eluded identification, it is

known that the dusts from the early stages of

processing are more hazardous than those from

later stages. Opening cotton bales and sorting,

picking, and blending raw cotton present greater

risks than do weaving and finishing.

In 1964, the American Conference of Governmental Industrial Hygienists considered the evidence for establishing a recommended limit for

cotton dust exposures. Two years later, the Conference agreed on a Threshold Limit Value of

1,000 micrograms/m3 as the maximum exposure

that was consistent with maintaining workers’

health. In 1969, the Secretary of Labor incorporated ACGIH’s recommended TLV into Federal standards for employers with Government

contracts (see ch. 11 for a discussion of the WalshHealey Act).

The Occupational Safety and Health Act of

1970 required that the newly established OSHA

adopt the Walsh-Healey Act standards and apply

them to all the Nation’s workplaces. Thus, the cotton dust standard of 1,000 micrograms/m3 was

adopted as a startup standard by OSHA in 1971

(see Ch. 12).

In 1974, ACGIH revised its TLV downward to

200 micrograms/m3 (the method of measurement

changed also, and the “new” 200 micrograms/m3

is not directly comparable to the ‘ old” 1,000

micrograms/m 3

). That same year, the Director of

NIOSH recommended that exposure to cotton

dust should be reduced to the lowest feasible level,

and that it should in no case exceed 200 micrograms/m3

.

In 1976 OSHA proposed a 200 micrograms/m3

standard. The final standard, issued in 1978, set

three different exposure limits—200 micrograms/m3

for cotton yarn manufacturing, 750 micrograms/

m

3 for “slashing and weaving” operations, and 500

micrograms/m 3 for exposures in other operations.

This standard was contested by the textile industry through legal suits. While the Supreme Court

upheld the standard for the textile industry in

1981, in the same year the current administration

moved to reconsider it. This action is pending.

Table 5-3 shows how the suggested and recommended levels for cotton dust came downward

after the substance was regulated as a health hazard in the United States.

Changes in Cotton Dust Levels

Table 5-4 presents North Carolina Department

of Labor measurements of the percentage of textile plant departments that were in compliance

with the OSHA cotton dust standard i n 1981. As

can be seen, just two years after promulgation of

the new standard and during the period the standard was being challenged in the courts, over half

the departments complied with the standard.

Some problems remain, as higher frequencies of

noncompliance were found in the early stages of

the process-opening, picking, carding, drawing,

and combing. In these stages, workers are exposed

to the more hazardous dusts associated with unprocessed cotton. overall, however, the cotton

industry is coming into compliance with the new

standard.

The industry trade association, the American

Textile Manufacturers Institute, estimates that

about 75 percent of the industry was in compli-
ance within two years of the standard being introduced. Some plants that have been completely

modernized are in full compliance (413).

In 1981, the U.S. textile industry purchased $1.6

billion worth of new machinery. About 70 percent of those purchases were for the purposes of

modernization to increase productivity (413) in

the face of increased foreign competition and, to

some extent, to comply with the OSHA standard for reduced cotton dust levels.

Ruttenberg (413) concludes that it is impossible to decide the relative importance of increasing productivity and compliance with OSHA regulations in the modernization of the American

textile industry’, but that both have made a contribution.

The U.S. Occupational Safety and Health

Administration dust regulations have had a dramatic effect on . . . processing equipment design

Photo credit O. SF/A, Office of Information and Consumer Affairs

The spinning of cotton fibers into yarn and weaving

yarn into fabric are two of the operations regulated by

the OSHA cotton dust standard. In recent years, the

textile industry has invested heavily in modernized

equipment in order to comply with the standard and

to improve productivity

and purchasing. Machine suppliers modified

equipment to comply with OSHA regulations and

this equipment has been accepted on a worldwide

basis as well as in the USA. The dust controls

have also contributed to much better operating

results. . . (U.S. Department of Commerce (551).

Quoted in 413).
88 . Preventing Illness and Injury in the Workplace

Table 5-3.-Suggested and Recommended Levels for Cotton Dust Exposure

Level a

Organization Year (micrograms/m3)

American Conference of Governmental

industrial Hygienists (ACGIH) . . . . . . . 1964

ACGIH recommendation . . . . . . . . . . . . . 1968

Secretary of Labor . . . . . . . . . . . . . . . . . . 1968

Occupational Safety and Health Administration (OSHA). . . . . . . . . . . . . . . . . . . 1971

British Occupational Hygiene

Society . . . . . . . . . . . . . . . . . . . . . . . . . . 1972

ACGIH recommendation . . . . . . . . . . . . . 1974

National Institute for Occupational

Safety and Health (NIOSH) . . . . . . . . . 1974

OSHA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1976

OSHA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1978

1,000

1,000

1,000

1,000

500

200

200b

200

tentative recommendation

formal

Walsh-Healey Act standard

OSHA standard

recommended standard for

Britain

formal

recommendation

proposed standard

final standard

~he levels from 1964 through 1972 were based on techniques that measured the concentration of total dust in the workplace

atmosphere. From 1974 on, the levels are based on the use of the vertical elutriator —a device that measures the quantity

of small, resplrable dust particles. Levels based on the these two methods are not dirwctly comparable

%he 200 limit is for yard manufacturing, 750 for slashing and weaving, and 500 for all other processes The Iim!t goes up

as the cotton dust becomes cleaner

SOURCE Adapted from (413).

Table 5-4.—Cotton Dust Measurements Before Promulgation of the

OSHA Cotton Dust Standard and Percentage of Companies

Claiming Compliance with the Standard in North Carolina

Range of measurements

before OSHA standard

Area of plant (micrograms/m3

)

Opening . . . . . . . . . . . . . . 300-3,000

Picking. . . . . . . . . . . . . . . 700-1,700

Carding . . . . . . . . . . . . . . 300-1,800

Drawing . . . . . . . . . . . . . . 400-800

Combing . . . . . . . . . . . . . NA

Roving . . . . . . . . . . . . . . . NA

Spinning ., , . . . . . . . . . . 200-300

Winding . . . . . . . . . . . . . . 1,200

Twisting. . . . . . . . . . . . . . 1,200

Slashing. . . . . . . . . . . . . . NA

Weaving . . . . . . . . . . . . . . 400-1,000

Knitting , . . . . . . . . . . . . . NA

Waste Processing . . . . . NA

Other . . . . . . . . . . . . . . . . NA

Companies claiming

Limit under compliance in

OSHA standard North Carolina

(micrograms/m3

) (percent)

53

200 61

200 52

200 63

200 61

200 81

200 83

200 76

200 80

750 100

750 96

100

85

500 97

SOURCE: (413).

Tougher government regulations on workers’

health have, unexpectedly, given the [U. S.] industry a leg up. Tighter dust-control rules for cotton

plants caused firms to throw out tonnes of old inefficient machinery and to replace it with the latest

available from the world’s leading textile machinery firms. (The Economist (160). Quoted in 413).

Costs of Compliance with the

Cotton Dust Standard

OSHA contracted for an economic analysis of

the expected costs of compliance with the cotton

dust standard, and the contractor assumed that

compliance would be accomplished by “add-on”
Ch. 5—Technologies for Controlling Work-Related Illness ● 8 9

ventilation equipment. However, the availability

of newer production equipment, which increased

productivity and reduced cotton dust exposures,

resulted in much lower costs than those estimated

at the time the standard was considered. As table

s-5 indicates, the initial 1974 estimates of capital

Table 5-5.—Estimated and Realized Costs of

Compliance with the OSHA Cotton Dust Standard

Millions of

1982 dollars

Preregulatory estimates

OSHA contractor, 1974 . . . . . . . . . . . . . . 1,941

Revised OSHA contractor, 1974 . . . . . . . 1,388

ATMl a contractor, 1977 . . . . . . . . . . . . . . 875

OSHA, 1978 . . . . . . . . . . . . . . . . . . . . . . . . 970

Postregulatory estimate

OSHA contractor, 1982 . . . . . . . . . . . . . . 245

aAmer~can Textile Manufacturers !rTStitUte

SOURCE (413)

costs for compliance were nearly $2 billion (in

1982 dollars). At the time of promulgation in

1978, OSHA estimated costs of just under $1 billion (in 1982 dollars). Thus, while cost estimates

plummeted more than 50 percent by the time the

standard was issued, the reduced estimate was still

almost four times higher than the actual costs reported in 1982 in a poststandard contract report.

Although most of the more productive, less

dusty machinery now in use in U.S. textile mills

was available in the mid-1970s, its potential use

was ignored in the early estimates of compliance

costs. Even if purchase of new technology had

been anticipated, it would have been difficult to

assign the proper fraction of its costs to dust control. In the event, new technologies greatly reduced the costs.

CASE STUDY:

CONTROLLING WORKER EXPOSURE TO SILICA DUST

Silica is a major component of the earth’s crust;

it is the sand covering the beaches, the sand

sprinkled on icy winter streets, the grit in the dust

on windy days—it is everywhere. It is also widely

used in industry. Over 402 million tons of silicacontaining sand were produced in the United

States in 1980. Of this total, nearly 300 million

tons were used for glassmaking, as molding sand

in foundries, and as industrial abrasives. Since it

is ubiquitous, silica is frequently found as an unwanted constituent of ores mined for other minerals.

In those cases, it must be removed and discarded.

Silicosis is a disabling lung disease resulting

from the inhalation, deposition, and retention in

the lungs of respirable crystalline silica dust. Acute

silicosis can occur within six months following exposure to extremely high silica dust concentrations. Silicosis victims appear to suffer more

episodes of chest illness than workers without the

disease. The mortality for nonmalignant respiratory disease is significantly higher among workers receiving compensation benefits for silicosis

than in the general population. A complication

of silicosis, progressive massive fibrosis, results

in significant impairment in lung function and

may result in respiratory failure and secondary

heart disease. Tuberculosis and other pulmonary

infections may complicate acute or chronic silicosis and significantly shorten life expectancy.

Hickey, et al. (210) discuss these silica-related

health problems and reported associations between worker exposure to silica dust and an increased risk of lung cancer.

Since diagnostic procedures do not detect

silicosis at a reversible stage, and since medical

treatment will not alter the course of the disease

after it is found, emphasis on exposure control

is imperative. Yet, even though the cause of the

disease has been well understood and technologies

for controlling exposure have been available for

decades, silicosis continues to occur in the United

States at an alarming rate. A minimum of 59,000

cases of silicosis may be expected based on knowledge about current exposure levels and numbers

of exposed workers at risk in 1980 in U.S. industry (210).

Hickey, et al. (210) estimate that there are 1.3

million production workers with potential exposure to silica dust—40 percent of whom are in
90 ● Preventing Illness and Injury In the Workplace

workplaces lacking exposure control. Historically

the most severe exposures to silica have occurred

in granite and stone working, foundries, mining,

and abrasive blasting. Workers producing and

using silica flour (silica ground so fine that it appears to be refined grain flour) have recently been

recognized to be at high risk for silicosis, because

of the extremely fine size of the particles produced.

Regulatory Activities for

Silicosis Control

The current OSHA standard for silica is based

on an equation that limits the total amount of free

silica to 100 micrograms per cubic meter. This

standard was adopted as a start-up standard in

1971 (see ch. 11). Evaluation of the silica standard shows that it may be inadequate at its present level. In 1974, NIOSH recommended limiting

silica exposure to 50 micrograms per cubic meter—half the current level. The studies on which

NIOSH based its recommendation used pulmonary function performance as the measure of

health effect—a more sensitive indicator of

silicosis than X-ray methods.

In certain circumstances, such as in abrasive

blasting where alternatives to silica are available,

substitution may be the most appropriate method

of control. The United Kingdom banned the use

of silica sand for abrasive blasting in 1948, and

NIOSH has recommended a similar prohibition

in this country (560). Sweden banned silica as an

abrasive in manual abrasive blasting in 1981 (210).

A California standard requires that prior to use,

not more than 1 percent, by weight, of abrasive

sand must pass a No. 70 U.S. standard sieve (0.3

mm). After use, the sand must have no more than

1.8 percent of its weight as particles 5 micrometers

or less in diameter (211). These restrictions on size

reduce the number of respirable particles.

In 1978, OSHA conducted a technological feasibility assessment and economic impact analysis for a specific standard addressing use of silica

sand in abrasive blasting (211). The study considered three alternatives: banning use of silica

sand in abrasive blasting, setting minimum criteria on size and hardness of blasting sand, and

controlling exposure through work practices. To

date no revised standard has been issued.

However, due to the serious silicosis problem,

OSHA has made a special effort to enforce the

existing silica standard. In 1972, silica was one

of five major health hazards selected for special

enforcement efforts in the ‘Target Health Hazard

Program” (414). Silica was again given priority

in the 1975 National Emphasis Program, as one

of the major worker health hazards in foundries

(339). In both cases OSHA industrial hygienists

focused health inspections on plants where silica

was likely to be found.

Control Technologies:

Engineering Methods

Silicosis is an entirely preventable disease. Exposure occurs whenever materials containing crystalline-free silica are processed and dust is generated. Processes include abrasion (sand blasting,

grinding, milling, etc. ) that creates dusts of particularly small particle size (less than 5 micrometers in diameter). These dusts are too small to be

easily seen as a “cloud.” Too small to settle, they

remain airborne and “respirable’’—-that is, they

may readily pass through the upper respiratory

passages and be deposited in the alveolar spaces

of the lung (the small air sacs deep in the lung

where gas is exchanged with the blood).

The most direct method of eliminating silica

dust is to substitute less hazardous materials for

the silica-containing material. This control has

been widely used in abrasive blasting operations

and to some extent in foundries. Silica-sand substitutes include metallic shot and grit, garnet, nut

shells, cereal husks, and sawdust. Olivine (magnesium iron silicate) has been used for mold making in foundries to reduce silica dust exposure, but

it is not clear how effective this method will be

(210).

Process change may also be used to control

silica dust exposure. For instance, water may be

added to foundry molding sand or sprayed on at

the point of dust generation in granite sawing and

processing of portland cement. In some situations,

dust-producing abrasive processes may be replaced by other types of cleaning such as salt

baths, acid pickling, or ultrasonic cleaning. Water

jetting and laser cutting for removal of excess

metal from castings have been considered as alter-
——

92 ● Preventing Illness and Injury in the Workplace

substitutes that are suitable for replacing silica. should be refined to provide a better way of

Also, for those situations where engineering con- worker protection. Information about the toxicity

trol maybe infeasible, further improvement in res- of silica and technologies for controlling exposure

pirator effectiveness is necessary. Medical proce- could be provided to workers and employers using

dures for detection of the early stages of silicosis it.

CASE STUDY:

CONTROLLING WORKER EXPOSURE TO LEAD

Early efforts against industrial lead intoxication

in this country were championed by Alice Hamilton. Her autobiography, Exploring the Dangerous

Trades (199), presents many examples of terrible

exposures that were corrected when managers and

owners were convinced that lead was causing the

“colic, “ “lead fits, ” and blindness that occurred

in lead workers. Until they were convinced, owners and managers preferred to believe that the illnesses resulted from bad personal habits—drinking, smoking, or the consumption of coffee.

Some firms refused to act voluntarily, and

states began passing “lead laws” in the 1910s that

set limits on occupational exposures. These early

efforts were the forerunners of the revised OSHA

lead standard, which was issued in 1978.

The current standard regulates exposure to lead

in over 40 different industries. With only few exceptions, most industries comply with the s O

micrograms/m3 permissible exposure limit for

workplace air concentration. The exceptions include primary and secondary lead smelting and

lead-acid battery manufacture, where controls are

most difficult and economic conditions have been

unfavorable. (Primary smelters purify lead from

lead concentrate, which is lead ore enriched by

milling. Secondary smelters recover lead from

discarded lead-containing products—in particular, worn-out batteries. Battery plants make leadacid batteries. ) Although the standard was contested by both union and management and it is

impossible to be certain of the future of these industries or of the burdens placed on them by the

standard, it is clear that workers’ health has been

improved as measured by reduced lead levels in

their blood.

Some Features of the OSHA

Lead Standard

The lead standard sets limits on ambient concentrations of the metal in workplace air, requires

engineering controls and work practices to reach

those limits, and requires that workers be informed about lead, its effects, and the methods

used to protect against them. TWO features—

Medical Removal Protection (MRP) and the extended time periods granted to selected industries

before engineering controls are required—distinguish the lead standard from other OSHA

health standards.

MRP requires employers to measure workers’

blood lead levels regularly. If the measured

concentration of lead in the blood exceeds certain

limits, the worker must be removed from lead exposure until the level drops to an acceptable value.

For up to 18 months, the employer must maintain the worker’s wages and seniority status even

if the person cannot perform his or her regular

job.

OSHA requires that air lead levels be reduced

to an effective concentration of 50 micrograms/m3

.

Since reported exposures have ranged above 2,000

micrograms/m 3

, reaching the regulatory limit

poses many problems for employers. The regulation gives companies 3 to 10 years to attain the

so micrograms/m3 limit through engineering controls; in the meantime, employers can require the
Ch. 5—Technologies for Controlling Work-Related Illness ● 91

natives to chipping and grinding in foundries.

Vacuum cleaning may be substituted for dusty

compressed air cleaning and screw conveyors used

instead of dust-producing pneumatic conveyors.

However, care must be taken to assure that such

treatment, while suppressing visible dust, also

controls the smaller, more hazardous, respirable

silica dust particles.

Where silica remains in use and worker exposure is possible, local exhaust ventilation may be

used to capture and carry dust away. Environmental Protection Agency or other ambient-air

standard regulations may require that ventilated

air be cleaned before discharge to the outside.

Control Technologies: Personal

Protection and Administrative Controls

Respiratory protection and face, eye, and body

protection against physical injury are also required by OSHA in specific regulations for abrasive blasting. NIOSH has specified the respirator

types required for protection from various air concentrations of silica, but these often prove to be

inadequate in practice (210). Employer-provided

and -maintained protective clothing and facilities

for changing at work plus training about personal

hygiene prevent exposed workers from exposing

family members to silica dust when taking work

clothing home.

NIOSH (and others) recommend: administrative measures that help reduce risk of silicosis;

training managers and workers about the hazards

of silica dust; the effective use of personal protection equipment; and work practices that prevent the generation of silica dust, Dust-reducing

practices include vacuum cleaning, regular maintenance of dust-producing and dust-controlling

systems, and good housekeeping. Dusty work

may be scheduled or located to reduce the number of workers at risk. However, Hickey, et al.

(210) report that company dust-control policies

are often unenforced.

Strategies for Silica Dust Control

One might ask why a well-recognized, entirely

preventable, work-related illness, for which the

etiology is understood and for which engineering

and other controls are available, remains a problem. Hickey, et al. (210) note some possible

reasons:

●

●

●

●

the current OSHA standard is inadequate

and based on outdated information,

compliance with the inadequate standard is

insufficiently monitored,

accurately measuring silica concentrations in

respirable dust samples is difficult and costly,

and

there is too much reliance on after-the-fact

control methods that control the dust after

it is generated rather than on methods that

eliminate silica dust.

An underlying reason for failure of worker protection against silicosis is the cost of controlling

exposures.

To attack this problem, Hickey, et al. (210) suggest promulgating a protective standard based on

the latest medical knowledge and streamlining enforcement by developing an accurate, inexpensive,

and rapid measurement method. These initial

steps will provide the basis for developing more

effective technology to prevent generation of silica

dust. Greater emphasis should be placed on preventing generation than on refinement of measures for control after the dust is generated. Research should be conducted to find nontoxic

Photo credit OSHA, Office of Information and Consumer Affairs

Abrasive blasting workers are frequently exposed to

high levels of silica dust
——

Ch. 5—Technologies for Controlling Work-Related Illness . 93

use of respirators to reduce workers’

to airborne lead.

Control Methods: Engineering

and Respirators

exposures

Table 5-6 lists categories of control measures

that can be employed to reduce lead exposures.

In general, major changes in processes will be introduced only when a plant is rebuilt for other

reasons. (An example of the costs involved in substituting a new process in primary smelters compared with adding on controls is presented inch.

16.) Add-on controls, in particular better ventilation, are probably the most common form of engineering controls, although far simpler controls—

such as covering stockpiles and putting tops on

reaction vessels—are an important part of engineering controls.

A number of process innovations are being

made in the secondary smelting industry and in

Table 5-6.—Measures To Reduce Air Lead and

Blood Lead Levels

A.

B.

c.

D.

E.

Measures that affect air lead levels in the plant

1. Changes in production processes (direct smelting

processes, more automated battery production

lines)

2. Add-on controls (ventilation systems)

3. Changes in operating practice (keeping floors

cleaner)

4. Greater or lesser use of lead-emitting equipment

Measures that do not affect air lead levels but limit

times workers spend in lead-contaminated atmospheres

1. Isolation booths with filtered air supply

2. Changes in work practices to limit time in high

lead areas

Measures that do not affect air lead levels but limit

workers’ lead absorption

1. Respirators

2. Showers, changing clothes before and after entering work areas

3. Business cycle factors: layoffs, overtime

Measures that do not necessarily affect exposure of

the work force as a whole but affect the distribution

of exposures among the work force

1. Monitoring of workers and removing those with

biological indicators of exposure to areas with

lower lead contamination

2. Rotation of workers

3. Firing of highly exposed workers

External measures that impact on lead exposure

1. Changes of lead level in out-of-plant environment

2. Changes of lead content in food and water

SOURCE (164)

battery manufacture that reduce worker exposure

to lead. A major source of lead exposure here has

been the breaking open of old lead storage batteries. Goble, et al. (184) mention two new processes that significantly reduce the liberation of lead

in that process. In addition, technological changes

recently introduced in the manufacture of new

lead storage batteries reduce worker exposure

while increasing productivity.

Table 5-6 includes personal protective equipment as well as business cycle factors that influence the number of workers exposed. The role of

respirators in providing protection until engineering controls are installed is clearly recognized in

the OSHA standard. The standard does require

that ultimately compliance shall be achieved

through the use of feasible engineering controls.

Medical Removal Protection

The OSHA lead standard provides that when

the amount of lead in a worker’s blood exceeds

a trigger level, he or she is to be removed from

exposure or placed in an area of lower exposure

until the blood lead level drops (see table 5-7).

When the amount falls to a specified reinstatement

level, the worker can return to his or her regular

job.

When the OSHA standard was being considered, employers pointed at MRP as a source of

high costs. They argued that older, more experienced workers who were paid a premium for their

knowledge would be removed to less skilled jobs,

causing losses in productivity. In addition, since

MRP requires that the worker’s wages be mainTable 5-7.—Blood Lead Levels That Trigger

Medical Removal From and Return to

Lead-Contaminated Atmospheres

Blood lead Ievelsa

(micrograms/100g blood) for

Date Removal Return

March 1979 . . . . . . . . . . . 80 60

March 1980 . . . . . . . . . . . 70 50

September 1981b . . . ~ . . 60 40

March 1983b . . . . . . . . . . 50 40

%Vorkers’ blood levels are to be monitored quarterly except workers with 10WJIS

greater than 40 micrograms/100g are to be monitored monthly.

b Many firmS have been given extensions of the time fOr the 60/40 and 50/40

trlgffers

SOURCE (164)
94 Preventing Illness and Injury In the Workplace

tained, experienced workers doing less skilled jobs

would still receive the pay associated with their

previous positions.

Table 5-8 summarizes three years’ data about

medical removal from companies seeking relief

from the lead standard. These data represent a

worst-case group and may not be representative

of the industry. In both the primary smelter and

the battery industries reported, the percentage of

workers on MRP transfer and the share of worktime spent on transfer peaked in the second year.

The data for primary smelters is reasonably complete, based on 5 of 7 smelters and about 2,120

workers each year, compared with a total of about

2,500 workers; it is less complete for the battery

industry, based on only 8 plants and about 1,300

workers in an industry that employs about 30,000

people. In the secondary smelting industry, the

percentage of workers on MRP and the proportion of worktime on MRP transfer increased each

year. The data in this case are certainly incomplete, and the facilities reported may not be representative of the entire industry; the data in table

5-8 are based on about 640 workers out of a total

of some 3,000 workers in the industry. If the data

are representative, the secondary smelters are encountering greater problems complying with the

OSHA standard.

Goble, et al. (184) compared the percentage of

total worktime on MRP transfer to projections of

transfers that had been made based on assumptions of so or 100 micrograms/m3 air lead levels

in the industries. They found that the reported

percentages of transfer worktime agree reasonably

well with achievement of 100 micro~grams/m3 air

lead levels, supporting the conclusion that effective air lead levels are between 50 and 100 micrograms/m3

. Given that blood lead levels are related

to worker health, these changes are evidence that

lead-related diseases and disorders should be

declining.

The number of terminations of workers because

blood lead levels remained above the reinstatement values even after removal to lower exposure

situations is apparently small. An examination of

the new-hire and termination rates before and

after imposition of the OSHA lead standard did

not show an increase. That observation is inconsistent with the idea that employers would terminate “leaded-up” workers and replace them

with new hires.

Changes in Air Lead Levels

Although some data about air arid blood lead

levels are available, they are often unsuitable for

making precise estimates of levels, of high exposure. For instance, although 67 percent of secondary smelter workers in 1977 were exposed to

greater than 200 micrograms/m3 airborne lead,

neither the maximum exposure level nor the average exposures of the highly exposed workers in

this group were reported. Goble, et al. (184) made

a number of assumptions and then calculated approximate average air lead exposure levels in the

three industries in 1977-78 and in 1981-82 (see

table s-9). Air lead levels dropped by about onequarter in primary and secondary smelting and

Table 5-8.—Medical Removal Protection Transfers in a Sample of Lead Industry Plants

Average number per plant Percent

Plants Lead exposed Workers on worktime

Industry Year In survey In industry workers MRPa transfer on MRP

1979 5 7 465 21 1.0

Primary lead smelting . . . . . . . 1980 5 7 419 31 2.1

1981 5 7 492 18 1.3

1979 6 36 120 4 1.0

Secondary lead smelting. . . . . 1980 6 36 104 9 4.6

1981 6 36 96 11 6.9

1979 8 136 176 2 0.4

Battery manufacture. . . . . . . . . 1980 8 136 140 8 1.9

1981 8 136 162 6 1.5

aMflP, M@c~ Removal Protactlon.

SOURCE: (1S4 from data available in 103).
—

Ch. 5—Technologies for Controlling Work-Related Illness ● 9 5

Table 5-9.— Reductions in Average Air Lead Levels,

1977-78 and 1981-82

Average air

lead levels

(micrograms/m’) Percent

Industry 1977-78 1981-82 reduction

Primary lead smelting. . . . . 740 565 24

Secondary lead smelting . . 285 205 28

Battery manufacture . . . 160 80 50

Seven battery plants . . . . . . 160 90 50

SOURCE (184)

by half in battery plants. Confidence about the

validity of these estimates, especially for battery

plants, is increased by the access Goble, et al. had

to detailed, company-collected exposure data

from seven battery plants. The percentage reduction observed in those plants is the same as the

calculated reduction for the industry overall.

The data in table 5-9 show what are probably

minimal estimates of reductions in air lead levels

because of systematic errors in the calculations.

Clearly, however, levels are coming down. Equally clearly, there is some distance to go before the

eventual goal of 50 micrograms/m 3 is reached.

OSHA recognized that engineering control of air

lead levels would take time, up to 10 years in some

industries. The decreases shown in table s-9 were

achieved in less than 5 years and during the period

when the standard was still being challenged in

the courts.

Changes in Blood Lead Levels

Data on blood lead levels for the period before

promulgation of the lead standard are not so plentiful as air lead data. The estimates shown in table

5-10 for 1977-78 are from information presented

in OSHA hearings. The data shown for 1981-82

are from measurements reported in a Charles

Table 5-10.—Average Blood Levels Before and After

Promulgation of the OSHA Lead Standard

Approximate average

blood lead levels

(micrograms/100g blood)

Industry 1977-78 1981-82 Difference

Primary lead smelting. . . . . 49.4 41.6 7.8

Secondary lead smelting . . 56.5 44.2 12.3

Battery manufacture . . . . . . 53.2 42.4 10.8

Seven battery plants . . . . . . 53.0 38.3 14.7

SOURCE (184)

River Associates (103) report prepared for OSHA,

and those are probably more reliable.

A satisfying drop in blood lead levels was seen

in less than 5 years between 1977 and 1982. Not

shown on the table is the finding that the number of workers with blood lead levels greater than

80 micrograms/100g blood dropped from l,553

(2 percent of 2,200 primary smelter workers plus

16 percent of 3,170 secondary smelter workers

plus 6 percent of 16,700 battery workers) to about

20 (0.1 percent of 2,470 primary smelter workers

plus 0.6 percent of 3,000 secondary smelter workers and no battery workers).

Furthermore, the number of workers with

blood lead levels above 40 micrograms/100g

dropped from 17,217 to 6,738. This significant decrease is especially important because that is the

lowest action level required at any stage of MRP.

In other words, the almost 9,000 workers who

have moved from the over-40 to under-40 micrograms/100g category are now at a level that

means they would not have to be removed from

their current jobs even as the threshold level for

medical removal drops.

In 1978, OSHA had estimates prepared of the

blood lead levels to be expected if the statutory

limits for lead were set and realized at 50, 100,

or 200 micrograms/m3

. The levels were expected

to fall as exposures decreased and workers eliminated some of the lead accumulated during their

previous high exposures.

Measured blood lead levels two-and-a-half

years after the introduction of the standard were

consistent with projections made on the basis of

achieving a level near so micrograms/m3 in the

battery industry and 100 micrograms/m3 in the

other two industries (184). These measurements

are somewhat surprising because the air lead levels

in the industries are above so or 100 micrograms/m3

. Effective respirator programs and attention to personal hygiene have probably contributed to the lowering of blood lead levels.

Although no blood lead level has been established below which symptoms are never found,

and there is no level at which symptoms will necessarily occur, there is agreement that lower blood

lead levels are associated with lower risks (174).
96 ● Preventing Illness and Injury in the Workplace

OSHA has established 40 micrograms/100g as an

action level; when the lead standard is fully implemented, workers with blood levels above 50

micrograms/100g must be removed from lead exposure until their blood lead levels drop below

40. The Centers for Disease Control (558) have

concentrated on 30 micrograms/100g as a level

at which concern should be raised.

costs

Capital expenditures for current controls run

at about $1,000 to $1,500 per worker each year.

To that must be added the expense of respirators,

clothing, and facilities for personal hygiene

(showers, changing rooms, etc.)–between $1,000

and $1,700 per worker per year. Monitoring and

medical surveillance cost about $500 per worker

annually, and the tranfer costs under MRP are

expected to run between $300 and $600 per worker yearly. Taken altogether, complying with the

lead standard is estimated by Goble, et al. to cost

between $2,800 and $4,300 per worker yearly.

In addition to the current costs, Goble, et al.

(184) project that future conventional industrial

hygiene controls will cost between $8,000 and

$9,000 per worker per year in secondary smelters

and battery plants. Future costs in primary smelters are expected to be lower, about $5,200.

Table 5-11 presents estimates of the engineering cost of reducing air lead levels to 50 or 150

Table 5-1 I.—Projected lndustry-Wide Annual Costs of

Compliance With Air Lead Levels of

50 and 150 micrograms/m3

Millions of 1962 dollars

Industry 50 150

micrograms/m 3 micrograms/m 3

Primary lead smelting . . 15.5 16.0

Secondary lead

smelting . . . . . . . . . . . 24.5 26.4

Battery manufacture . . . 97.4 not done

SOURCE: (1S4).

micrograms/m3. The costs are quite close. One

reason is that (according to engineers employed

by Charles River Associates (184)) the best conventional engineering controls will not reduce exposure to 150 micrograms/m3

. Another reason is

that isolation booths, if installed, could reduce exposures to less than 50 micrograms/3 for about

the same as it would cost to reach 150 micrograms/m3

.

Major process changes, although costing more

in capital expenditures, are expected to result in

operating savings. In general, the capital costs of

process change may be appropriate if a new plant

is to be built, but they outweigh the costs of addons in an existing plant unless significant tax savings or credits accompany installation of the new

process.

Summary of Improvements

The data about workplace air lead and blood

lead levels show that both have decreased since

the issuance of the OSHA lead standard. While

the air lead levels have dropped about 25 percent

in primary and secondary smelters and about so

percent in battery plants, they still remain much

higher than 50 micrograms/m3 that is the goal of

the standard. At the same time, however, blood

lead levels have dropped appreciably, and in general are close to the levels predicted for reaching

air lead levels between 50 and 100 micrograms/m3.

A number of factors—including decreases in lead

uptake from the environment in general, changes

in the methods for measuring lead, errors in the

model that is used to project blood leads based

on air leads, and greater-than-expected impacts

of respirator programs and hygiene practices—

have contributed to the apparent better realization of reductions in blood levels than was predicted. Whatever combination of factors is responsible, the falls in blood lead levels are gratifying

and bode well for better health among lead

workers.
Ch. 5—Technologies for Controlling Work-Related Illness ● 9 7

EXTENT OF CONTROL TECHNOLOGY USAGE IN THE UNITED STATES

The National Occupational Exposure Survey

(NOES) (see chs. 2 and 12) includes data that describe the extent of the usage of control technologies for the prevention of work-related illness.

NOES, conducted from 1980-82, estimates the extent of worker exposure to potentially hazardous

workplace agents. This survey was conducted as

a followup to a similar survey, the National Occupational Hazard Survey, conducted in 1972-74.

The sample of businesses in the NOES survey

consists of approximately 4,000 establishments in

67 metropolitan areas throughout the United

States. The sample represents all nonagricultural

businesses covered under the Occupational Safety

and Health Act. Data were collected onsite by

teams of engineers and industrial hygienists specially trained for the survey.

NOES was conceived for the purpose of recording specific worker exposures to potential workplace health hazards. Among the questions that

the survey attempted to answer were:

●

●

●

●

●

What occupational groups are exposed to

what types of potential health hazards in the

United States?

In what types of industries are these hazards

found?

What control technologies are present to prevent work-related disease in terms of plant

operation and occupational safety and health

practice?

What are the exposures by intensity, duration, type of control?

What trade name products were present?

Both surveys included questions about demography and occupational safety and health practice, followed by a walk-through survey of the

plant work area to inventory potential exposures.

A series of questions specifically aimed at the practice of using controls was asked in NOES.

With the control questions asked in NOES it

is possible to analyze the extent of engineering

control usage in the manufacturing sector of the

country. Areas include practices of material substitution, process change, and the management

of personal protective equipment programs. These

data are unique in that there are no other comprehensive assessments of work-related exposure

control practice. Control technology usage may

be classified by plant size and by industry, allowing distributions to be done for comparison.

These data may be used to pinpoint patterns

of control technology use within and among industry groupings, giving insight about areas where

improvement is needed. This analysis may also

be used to assist in setting priorities for control

technology research.

Information About Controls and

Areas for Research

The vinyl chloride, industrial solvent, lead, cotton dust, and silica examples show that control

technologies for workplace exposures can be engineered once commitment to control is made.

Commitment, however, is often difficult to

achieve. For example, in the regulatory proceedings concerning new health standards, arguments

are often raised about the harmful health effects

of existing exposure levels, and the costs and feasibility of controls (see ch. 14 and box 12-1 in ch.

12). In addition, opposition to some governmental

regulation may result simply from employers’ concern that an outside authority is telling them what

they must do to protect workers.

However, as shown by the vinyl chloride and

cotton dust examples, the installation of technologies to control workplace hazards can be accompanied by greater productivity. As seen in the case

of the ventilation control system in the electronics
98 . Preventing Illness and Injury in the Workplace

industry, there are advantages to planning, installing, and maintaining control technologies in a systematic way. Anticipation of work-related health

problems very often reduces the cost of their

control.

Access to information about control technologies for workplace health and safety could be

improved. Perhaps the greatest current need is for

published information about controls in the occupational safety and health literature. While there

are journals dedicated to toxicology and epidemiology, there are none specific to industrial hygiene

engineering. Industrial hygiene journals infrequently and engineering technical journals only

rarely include articles about technologies for controlling worker exposure to hazardous materials.

Yet it has been suggested that such information

should be part of every engineer’s training and

be readily available as reference material to the

practicing engineer (587).

Published information about specifics of workplace control is sparse for several reasons. First,

and probably most significantly, companies that

develop controls simply do not take the time to

publish details since it is not their business. On

the other hand, it is likely that some consider the

information proprietary and keep it unpublished

for competitive reasons.

In some cases, such as for the control of exposures to vinyl chloride, a few companies market

new technology for preventing work-related injury and illness. This, however, appears to be infrequent and be limited to very large companies

such as B.F. Goodrich and Dupont. Probably

most companies that have found and use innovative control technologies in their plants simply

have yet to explore workplace control technologies as a market.

University and government researchers have

published some practical information that can be

used by design engineers but the volume of this

material is limited. One widely used handbook

specific to ventilation is the ACGIH Ventilation

Manual that is published annually (6). Programs

such as the NIOSH Control Technology Assessments have produced useful information for hazard control in some specific and some generic

manufacturing processes (see ch. 12).

There is also a dearth of new approaches in this

area. For instance, First (173) pointed out that little

has been added to the theory of ventilation since

two Ph.D. theses done at Harvard in the 1930s.

The tendency has been to retrofit control solutions after problems appear rather than to anticipate them. Yet there is promise of new methods on the horizon.

Brief and colleagues (74), recognizing the limitations of retrofit solutions in preventing workrelated injury and illness, have explored techniques for designing new plants with new control

systems built in. They have found that in the past

retrofit control procedures were recommended

without being able to judge the effectiveness of

controls, until after installation and operation.

This retrofit approach is probably not as cost effective as designed-in controls, although cost effectiveness was rarely tested. In many cases additional administrative and personal protective

programs were used to achieve desired worker

protection.

We have embarked on a new era involving

some major companies and government agencies

investigating the impact of engineering design on

the workplace environment. The objective is simple. It states that we will attempt to design into

our plants and operating facilities the necessary

engineered controls to meet occupational health

standards. Intuitively, we believe that it is more

cost-effective to install engineering controls in new

plant designs than to retrofit later. Equally as important is the practicality of having an environmentally sound plant at the start, rather than one

which requires modifications later. Retrofitting .

controls may be difficult to implement due to

physical factors and the time to implement the

changes after the plant is running.

In this innovative approach, design is based on

selection of process equipment controls appropriate to the process. The key is to determine emission rates of contaminants from each type of process equipment used. These data may then be used

to build a near-field dispersion model (a mathematical expression of the release and buildup of

contaminant in workers’ breathing zones) to calculate collective concentrations to which workers could be exposed. By trying various combinations of equipment and controls in the model and

testing them against recommended health stand-
Ch. 5—Technologies for Controlling Work-Related Illness 99

ards, engineers can predict potential worker ex- plied, particularly in plant design stages. Technolposure and thus design processes with optimum ogies are available but information about specific

worker protection and production. These in- solutions is difficult to find because it is seldom

vestigators stress the need for interaction between published. Retrofit is the dominant mode even

engineers and occupational safety and health pro- though there is recognition that solutions should

fessionals at the design stage for this to succeed. be designed into new processes.

Thus, control technology for work-related illness prevention is possible but insufficiently apSUMMARY

Workplace exposures to toxic substances can

be controlled at their source, during transmission,

and at the worker. Control at the source includes

changes in the design of a process and substitution of nontoxic or less toxic materials. Controlling the transmission of a toxic substance can be

done by isolating or enclosing hazard sources,

wetting toxic dusts to prevent dispersion, installing local exhaust ventilation to capture and carry

toxic substances away, or reducing toxic concentration through the use of general dilution ventilation. Control at the worker includes the use of

personal protective equipment (see ch. 8), work

practices, and administrative procedures. Engineering controls that can be designed into a work

process to control hazard sources and dispersion

of contaminants are preferred to other measures

that may provide less reliable protection. Training (see ch. 10) of supervisors and workers is required to make sure control programs are effective.

Three case studies prepared for this assessment

provide information on controls for health hazards. Exposures to cotton dust cause a debilitating

respiratory disease known as byssinosis. In the

years following the issuance of a revised OSHA

health standard concerning cotton dust, the U.S.

textile industry has invested heavily in modernizzing its operations. The new equipment has led to

improved productivity in this industry, as well

as reduced worker exposures.

Data about workplace air lead and blood lead

levels show that both have decreased since the issuance of the revised OSHA lead standard in

1978. The possible factors to explain the improvements in blood lead levels include changes in exposures to lead in the workplace air, the use of

medical removal protection, decreases in the

amount of lead absorbed from the environment,

changes in lead measuring methods, and improvements in respirator programs and hygiene practices.

Silicosis—a disabling lung disease-is caused

by silica dust. Control measures include substitution with safe abrasives, ventilation, wetting,

as well as the use of respirators, work practices,

maintenance of ventilation systems, and good

housekeeping practices.

A considerable amount of information about

how to design and implement control technology

for worker protection is available but is not widely

disseminated. Research on improved control technology design and implementation is also needed.

For example, little has been added to the basic

theory about ventilation since the 1930s. The National Occupational Exposure Survey conducted

by NIOSH collected information which will give

estimates of the extent of worker exposure to potential hazards and the current practice of control technology use. These data can potentially

assist in setting priorities for research on improved

controls.
6.

Technologies for Controlling

Work-Related Injuries
Contents

Page

Preventing Motor Vehicle-Related Injuries and Fatalities . . . . . . . . . . . . . . . . . . . . 106

Preventing Construction-Related Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106

Preventing Manufacturing-Related Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108

Woodworking Processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108

Metalworking--Cutting, Welding, and Cold Forming.. . . . . . . . . . . . . . . . . . . . 109

Metalworking-Hot Working.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111

Preventive Maintenance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .....9... 112

Fire and Explosion Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113

Injury Control Programs Industry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116

The DuPont Injury Control Program .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117

summary .. ● ● ....... ● . ● . ● . . ● . ● . ● . ● . . . . . . . ● .. ● . ● . ● . . . . ● . . . ● ● . . ● . ● ● 118

LIST OF TABLES

Table No. Page

6-1.

6-2.

6-3.

6-4.

6-5.

6-6.

6-7.

6-8.

6-9.

6-10.

Principles of Preventing Work-Related Injury . . . . . . . . . . . . . . . . . . . . . . . . . 104

Prevention Checklist To Be Used Before Starting a Production Plant . . . . 105

Examples of Injury Control in Plant Layout .. .. a s . . . . . . . . . . . . . . . . . . . . 105

Technologies for Preventing Work-Related Injury From

Woodworking Machinery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109

Technologies for Preventing Work-Related Injury From

Metalworking Machinery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111

Technologies fo r Preventing Work-Related Injury During Work with

Hot Metal in Foundries . . . . . ● . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112

Technologies for Preventing Work-Related Injury Through Maintenance

of Structures ..... ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113

common Ignition sources of Industrial Fires ● ● ● . ● . .... ● .. ● ● ● ● ● . 114

National Fire Protection Association Fire Classification . . . . . . . . . . . . . . . . 116

Du Pont Calculations of Cost Savings From Injury Control . . . . . . . . . . . . 118
Technologies for Controlling

Work-Related Injury

Injuries are caused by “abnormal energy transfers or interferences with energy transfer” (198).

One analytical method breaks the injury-causing

event into three parts: 1) the source of hazard,

2) its transmission, 3) and the worker; this method

is patterned after the traditional public health

model of disease transmission (“agent,” “vector,”

and “host”).

Control technologies suggested by this approach consider: control at the source of energy,

control of transmission of energy, and control at

the worker. Although there are many similarities

between safety engineers’ approach to injury control and the public health approach, their terminology and methods have usually been quite

different. Safety engineers have tended to use

codes, standards, and models of “good practice”

that are oriented around particular topics: fire prevention, electrical safety, design of machinery,

plant layout, etc.

This chapter describes how designers and engineers can plan sites, plant layout, and equipment

design in order to prevent work-related injury.

“Safe” design presents particular difficulties in the

construction industry where constantly changing

conditions create constantly changing workplace

hazards against which workers must be protected.

In manufacturing, the worksite is relatively more

stable but there is still a great deal of worker exposure to hazardous releases of energy. Fire and

explosion prevention is an area that not only can

prevent human deaths and injuries, but also can

prevent very large economic losses. Probably for

that reason, fire and explosion prevention has received a great deal of attention from the safety

profession.

Finally, this chapter discusses injury prevention

programs. Because management has the primary

responsibility for prevention of work-related injury and illness, a successful injury prevention

program must start with a strong commitment

from management. The stronger the commitment

at the top, the greater the likelihood of success.

The success of one such program is illustrated by

a discussion of the injury prevention program of

one large company—Du Pont.

Workplace injuries can be prevented by proper

design of structures, machines, and operations (see

table 6-l). Proper design considers the stresses to

be placed on the building structure, the arrangement of spaces for the work to be accomplished,

and specific safety requirements. For example,

falls on working surfaces, the single most common cause of workplace injuries (13.5 percent of

all nonfatal injuries), can be largely prevented by

designing proper walking and working surfaces.

Appropriate design, including safe construction

plans, can prevent work-related injuries as buildings go up and equipment is installed. Structure

collapse during concrete pouring may kill or injure a number of workers at once. Such catastrophes get media attention whereas the bulk of

work-related injuries and fatalities that occur

singly do not. One disaster at Willow Island, WV,

Photo credit: Office of Technology Assessment

The rear of this construction site shows the use of

shoring to prevent the collapse of surrounding soil

103
104 . Preventing Illness and Injury in the Workplace

Table 6-1.-Princlples of Preventing Work-Related Injury

Injury-prevention Relevant

objective Examples control principle

1. To prevent the creation of the hazard.

2. To reduce the amount of hazard.

3. To prevent release of the hazard.

4. To modify the rate or spatial

distribution of release of the hazard.

5. To separate, in time or space, the

hazard and that which is to be

protected.

6. To separate the hazard from workers by

interposition of a material barrier.

7. To modify relevant basic qualities of the

hazard.

8, To make what is to be protected more

resistant to damage from the hazard.

9, To counter the damage already done.

10. To stabilize, repair, and rehabilitate the

object of the damage.

One-story buildings reducing need for ladders

Reducing speeds of vehicles.

Bolting or timbering mine roofs.

Brakes, shutoff valves, reactor control rods.

Walkways over or around hazards, evacuation.

Operator control booths.

Using breakaway roadside poles, making crib

slat spacing too narrow to strangle a child.

Making structures more fire- and earthquakeresistant.

Rescuing the shipwrecked, reattaching severed

limbs, extricating trapped miners.

Posttraumatic cosmetic surgery, physical

rehabilitation, rebuilding after fires and

earthquakes.

Elimination, substitution

Process design

Enclosure

Ventilation

Isolation Administrative

controls

Isolation, Personal

protective equipment

Process design

Process design

NA

NA

SOURCE: (71,197).

in 1979 was found by the Occupational Safety and

Health Administration (OSHA) and National Bureau of Standards investigators to be related to

concrete failure from improper pouring and from

insufficient allowance of curing time. The National Institute for Occupational Safety and

Health (NIOSH) (584) is refining equations to predict more accurately concrete’s curing time as an

aid to preventing similar disasters.

In 1981, 11 workers were killed and 23 injured

in Cocoa Beach, FL, when a five-story building

collapsed during placement of a concrete roof

slab. Analysis of this catastrophe showed two factors

●

●

caused the failure:

A design error: a check for punching shear

(the stress or force around holes cut in beams)

was omitted.

A construction error: supports for reinforcing steel other than those-specified by the design were used and proved to be inadequate.

A failure at one column precipitated a progressive failure of the slab, which, when it fell, caused

successive collapse of all lower floors (271). Tragically, this disaster closely resembled a collapse

of similar construction in Jackson, MI, in 1956.

Information about these and other failures is

now available in a data base maintained by the

University of Maryland’s Architecture and Engineering Performance Information Center. This

computer compilation of analyses of design errors enables designers and engineers to search for

and compare information on failures of similar

designs.

Checklists have been developed for engineers,

architects, and designers to guide their attention

to methods of reducing injury risks. An abbreviated example of such a list is given in table 6-2.

Codes and standards for building structure, for

steam, heating, and electrical systems, and for fire

and injury prevention are also used as design criteria. The sources for these codes include the

American National Standards Institute, the National Electrical Codes, the National Fire Protection Association (NFPA) Codes, OSHA regulations, and recommendations made by NIOSH.

Site planning and plant layout for location of

buildings, facilities, and processes and other design practices can be done in ways to prevent

work-related injury. Table 6-3 provides examples

of injury control practices that are possible
Ch. 6–Technologies for Controlling Work-Related Injury 105

Table 6-2.—Prevention Checklist To Be Used Before

Starting a Production Plant

Section l—Boiler and machinery review

A. Boilers

B. Pressure vessels

C. Piping and valves

D. Machinery

Section n-Electrical safety review

Section Ill—Fire protection review

Section lV—Personnel safety review

A. Project site location

B. Building and structures

C. Operating areas

D. Yard

Section V—Process safety review

A. Materials

B. Reactions

C. Equipment

Section Vi—Environment control audit

A. Atmospheric discharges

B. Liquid discharges

C. Solid discharges

Section VIl—Periodic plant loss prevention

review (manufacturing) to:

A.

B.

C.

D.

E.

Keep operating personnel alerted to the hazards.

Determine whether operating procedures require

revision.

Carefully screen the operation for changes that may

have introduced new hazards, or changes that

should be made to reduce existing hazards.

Reevaluate property and business interruption loss

exposures.

Uncover potential hazards not previously recognized, especially in the light of experience or new

information.

SOURCE (172)

Photo credit: Department of Labor, Historical Office

Electrocutions account for about 6 percent of reported

work-related fatalities

through plant layout. The isolation of hazardous

materials and machinery, for instance, can be

achieved through building special rooms or buildings. Falls can be prevented by providing adequate

walkways and lighting. Again, specific codes are

available to guide designers and planners in these

areas.

Many vehicular-related injuries and fatalities

in and around factories maybe prevented through

Table 6-3.—Examples of Injury Control In Plant Layout

Source of injury Design solutions

Contact with moving machinery

Potentially explosive or inflammable processes

and substances

Crane loads striking worker

Building fire

Chemical burns

Falls from trestles

Falls in pits or bins

Falls on stairs and from ladders

Electrocution and electrical burns

Being caught in machinery during maintenance

Being caught in machinery during operation

Explosion related to broken light bulbs

SOURCE (322)

Adequate space between and around machines

Remote siting; separate buildings to contain explosion or fire;

isolated storage areas

Site cranes away from work areas

Adequate space between buildings to prevent spread of fire

Use corrosive-resistant containers, remote siting, and special

handling procedures

Provide adequately wide walkways along trestles, and adequate

lighting

Provide grating screens and covers, and adequate Iighting

Design stairs with non-slip tread; provide adequate lighting

Adequate grounding; wiring inaccessible to inadvertent insulation

wear

Interlocks and tag-out procedures to prevent inadvertent start-up

Adequate illumination

Special lamps and enclosures where physical conditions may shatter

ordinary bulbs
I&i ● Preventing Illness and Injury in the Workplace

careful planning of transportation facilities, including shipping and receiving departments, railroad sidings, parking lots, and roadways. Worksite roadways and walkways can be laid out and

designed according to safe engineering practices

to prevent traffic-related injuries. Adequate anticipation of traffic to, from, and during work and

landscape design to eliminate blind spots can also

reduce risk. Railings on stairs and walking inclines

prevent falls.

Shipping and receiving, whether by truck,

train, ship, or airplane, pose special potential for

work-related injury. Facilities can be designed to

reduce overexertion and back injury by providing working surfaces at correct height and allowing room for mechanical lifting devices. Shipping

and receiving docks can be isolated to prevent

harm from mishap when loading or unloading inflammable, explosive, or extremely toxic substances and from falling objects.

Sensible plant layout, including consideration

of headroom, aisle width, and access for maintenance can both lower injury risk and increase productivity (322). Clearly, the risk of injury is reduced by designing work stations that are located

away from hazardous areas.

PREVENTING MOTOR VEHICLE= RELATED INJURIES AND FATALITIES

Analysis of injury statistics shows that motor

vehicle-related fatalities account for 30 to 40 percent of work-related fatalities and are among the

5 leading causes of work-related injuries (see

Working Paper #l). While a good deal of public

attention is given to “defensive driving, ” speed

limits, collision protection through passive and

active restraints, and reducing the number of

drunk drivers, little of the industrial injury-prevention literature relates to the occupational use

of motor vehicles (40).

precautions. For example, braking systems on

earth-moving equipment, large trucks, and long

distance tractor-trailers should be maintained with

emphasis on safety rather than mere schedules.

Drivers should be properly trained to operate

equipment safely under different road and weather conditions. Vehicles used for employee transport should meet appropriate requirements for

both driver and passenger safety; for example,

proper emergency exits should be available to

allow escape.

An insurance company has prepared a handbook that describes both routine and particular

PREVENTING CONSTRUCTION= RELATED INJURIES

The lost-workday rate from job-related injuries

is much higher in the construction sector than the

all-industry average. The constantly changing

conditions of construction sites create a variety

of workplace hazards against which workers must

be protected.

Specialized, often large, machines that come

and go to construction sites bring their own mechanical energy-related hazards. The “beep-beepbeep” of backing earth-moving equipment alerts

workers on the ground; the cages around drivers’

seats protect against falling and swinging objects

and from being crushed if the machine tips over.

Seat belts or other restraining devices protect vehicle operators from harm during collisions.

A frequently reported cause of injury is falls

from heights—31 percent of construction fatalities. These may occur from inappropriate ladders,

improperly erected scaffolds, poorly designed

temporary stairs, or inadequately protected openings in floors, elevator shafts, and roofs under

construction. Yet available equipment and procedures can protect against each of these hazards.

Manufactured ladders that meet codes and ladders constructed on the job that meet minimum

requirements will reduce the number of falls. Rail-
Ch. 6—Technologies for Controlling Work-Related Injury ● 107

Photo credit Department of Labor. Hisforlcal Office

Earthmoving equipment is now built to include

protection from falling objects and accidental rollovers

Photo credit: OSHA, Office of Information and Consumer Affairs

Falls from heights are a frequent source of fatal injuries

in the construction industry

Photo credit OSHA, Office of Information and Consumer Affairs

Improperly shored trenches can be a source of serious

injury when laying pipes and pipelines

ings that are sufficiently strong and high will prevent a worker from slipping through openings

inadvertently. Adequate scaffolds have been described for particular construction tasks; bricklaying and stonework require sturdier scaffolding

than light carpentry.

Another source of injuries and fatalities is

trenching. Collapsing trenches can bury workers

alive. This can be prevented by shoring trenches

or by sloping trench sides as they are dug to prevent collapse.

Scaffolding, railings, and blocked holes in floors

under construction are day-to-day steps taken to

prevent injury. These temporary measures must

be put up, taken down, and supervised each day

or as each floor in a new building is completed.

Construction workers depend on personal protective equipment —hard hats, gloves, and steeltoed shoes-for immediate protection but consideration of worksite layout to prevent workers

entering areas likely to be filled with flying objects plays an important role in preventing construction-related injuries and death.
108 ● Preventing Illness and Injury in the Workplace

In all these cases, the persons responsible for

safety must be given authority to require that precautions be taken. The urgency to finish a job and

the false confidence that comes with “I’ve done

it a thousand times this way” lead both workers

and management to ignore hazards. These human

tendencies are among the reasons that involvement of management from the top down is necessary for injury control.

Photo credit: OSHA, Office of Information and Consumer Affairs

Mechanical power presses are an important safety

hazard in many manufacturing plants

PREVENTING MANUFACTURING= RELATED INJURIES

Though the rates are not as high as the construction industry, the manufacturing sector still

has injury and illness rates higher than the allindustry average (see ch. 4 and Working Paper

#l). It also offers many opportunities for injury

prevention because it is a relatively stable work

environment. Workers make products generally

using the same methods day after day, while management closely controls the entire operation.

Manufacturing involves applying energy to

wood, metals, or other materials to shape them

into usable products. Even handtools multiply

human muscle forces greatly; the cautionary instructions about hammers, screwdrivers, saws,

and snips delivered from parent to child or from

teacher to student often include gory descriptions

of injuries known first or second hand. Power

tools move faster, generate greater energy, and,

hence, involve a greater degree of hazard.

The following selected examples of dangerous

operations among the wide variety found in manufacturing operations illustrate injuries that may

be related to manufacturing and provide a summary of control strategies.

Woodworking Processes

Table 6-4 lists woodworking processes, possible injuries, and preventive technologies. Devices

used to cut, shape, and join wood—including a

variety of power saws, planers, shapers, lathes,

and routers—are capable of causing serious injury, especially to the hand or eye. Preventing

such injuries depends on design of special guards,

on work practice, and on personal protective

equipment. For instance, a guard would prevent

contact with a power saw, a lock would prevent

the saw from being turned on while maintenance

work is in progress, and gloves and goggles would

protect the worker’s hands and eyes from flying

chips.

Many items of equipment can be purchased

with built-in guards (322). There is general agreement that built-in guards are less expensive, more
Ch. 6—Technologies for Controlling Work-Related Injury 109

Photo credit OSHA, Office of lnformation and Consumer Affairs

Improper use of powered woodworking tools, such as

this saw, can lead to serious injuries,

including cuts and amputations

effective, and less likely to interfere with production than “bolt-ons.” Unfortunately, the extra

cost—coming at a time managers are spending

money on new machinery-may inhibit purchase

of the safer equipment.

Metalworking— Cutting, Welding,

and Cold Forming

The most casual sidewalk superintendent can

appreciate the hazards inherent in welding and

cutting metals. These involve high temperatures,

hot metal, and intense visible and ultraviolet light.

Table 6-5 shows a summary of the potential hazards of each process and gives examples of the

types of control technologies that can be used to

prevent injury.

The hazards of welding and cutting are similar. Skin may be injured by infrared, visible, or

ultraviolet radiation or by fire, hot metal parts,

explosions, or electrical shock. Eye injury or burns

may result from flying sparks, hot metals, or the

immensely strong light emitted in the infrared, visible, and ultraviolet spectrum. Gases including

oxygen, acetylene, hydrogen, and others, usually

stored under pressure in special cylinders, may

explode, or injury may result from physical handling of the cylinders. Shielding can protect adjacent workers, and face masks can protect the

welder (322). One type of welding—resistance

welding— is usually done by a special machine

that eliminates many sources of injury.

Table 6-4.—Technologies for Preventing Work-Related Injury From Woodworking Machinery

Process, Injury Examples of prevention

device, or tool potential technology available

Saws Cuts, amputation, eye damage, Kickback and hood guards, jigsa

, operating methods, push

projectile wounds, hearing loss sticks, maintenance goggles, hearing protectors

Jointers, planers Hand and finger cuts Swing guards, hold down clamps, maintenance

Shapers Hand and finger cuts, projectile Use of solid cutters instead of knives, maintenance, safety

wounds collars, brakes, operating methods, holding jigsa

, goggles

Power-feed Hearing loss, projectile wounds Isolation, goggles, maintenance, hearing protectors

planers

Sanders Abrasions, projectile wounds Guards, goggles

Lathes Eye and projectile wounds Goggles, face shields

Routers Hand cuts Jigs a with handles

 device for mechanically holding a of work in the correct position while working on 

SOURCE (322)
110 ● Preventing Illness and Injury in the Workplace

Photo credit Department of Labor, Historical Office

Lack of attention to prevention can result

in equipment collapse

Cold forming involves applying great cutting

and punching forces to metal. The power of the

machines for turning, boring, milling, planing,

grinding, and power pressing is a obvious hazard. Table 6-5 also includes a summary of the

types of injuries associated with these machines.

Cuts, eye injuries, injuries from being caught in

the machine, and foot injuries from dropping

heavy chucks (devices that hold the cutting tool

in place during machine work) are the main problems. Control technology ranges from careful design that considers safety to personal protective

equipment.

OSHA and NIOSH studied self-tripping power

presses that use presence-sensing devices such as

photoelectric detectors and light beams to prevent

hands from entering the presses. Use of these dePhoto credit” OSHA, Off/cc of Information and Consumer Affairs

The hazards of welding include heat, flying sparks,

and fumes, as well as infrared, visible,

and ultraviolet radiation

vices to activate power presses could increase productivity as compared with the use of two-handed

switch activators. Although photoelectric devices

for these purposes are ordinarily prohibited by

an OSHA regulation, a variance was granted to

one company to evaluate the relative degree of

injury control among workers using self-tripping

devices and those using two-handed switches. Investigations found no significant difference in

observed injuries or stress as measured by heart

rate, blood pressure, and subjective responses to

a questionnaire among the two groups of workers tested (588).

Although the photoelectric devices provide protection equal to traditional methods, and at the

same time increase productivity, NIOSH studies

have found other innovations less positive. For

instance, presence-sensing devices that halt machine operation when a worker’s hand interrupts

a radiofrequency field in the danger zone proved

inadequate for reliable injury prevention. These

studies have also shown that the current standards for two-handed activator switches for power

presses may be inadequate. Under some condi-
—

Ch, 6—Technologies for Controlling Work-Related Injury ● 111

Table 6-5.–Technologies for Preventing Work. Related injury From Metalworking Machinery

Process, Injury or illness Examples of prevention

device, or tool potential technology available

Welding and cutting Shock trauma; eye injury; back injury from

handling heavy gas cylinders; cuts from

sharp edges on finished work; hearing loss

Metalworking machinery; Eye injury (flying chips), scalping (hair

turning machines; boring caught in machinery), foot injury from

machines (drills, boring dropped chucks; hand, finger, or limb

mills); milling machines injury; skin irritation (cutting fluids),

(saws, gear cutters, electrical shock (EDMa

)

electrical discharge—

EDM

a

); planing machines

Grinding machines

Power presses; hand- or Finger or hand amputation or injury; finger

foot-operated presses; punctures; fatigue; eye injury, foot injury;

metal shears; press brakes lacerations

a Mlll!ng by electric arc

b sy~tem~ for Preventing (nadvertanf machrne operation during mafnfenance

SOURCE (322)

tions workers could activate the power press and

have time to reach into the press before the press

ram completes its cycle (588).

Metalworking—Hot Working

Hot metal work is done primarily in foundries.

It is characterized by massive, often older, machinery. The size of the operations and the weight

and heat of the materials being worked result in

many injuries. The processes range from handling

raw material—ore concentrates, coal, coke—to

working with heating and shaping ovens and proCareful layout of equipment, process, and

job; arc and spark-shielding; proper

insulation of electrical cable; goggles;

welding hoods; welders’ helmets; gloves;

ultraviolet-energy-resistant clothing

Machine design, including shielding, proper

electrical insulation, local exhaust

ventilation for grinding wheel discharge and

for discharge gases from EDMa machines,

provision of emergency stop buttons

Safe working practices, including keeping

tools sharp, never leaving machine

unattended, using handtools instead of

hands to work metal

Inspection of grinding wheels for integrity

and balance; good maintenance; shields to

prevent flying chips; use of personal

protective devices, including goggles,

hearing protectors, closely fitted clothing,

haircaps, safety shoes

Enclosure of the die during operation;

adjustable, fixed, or interlock press barrier

guards; point-of-operation safe-guarding with

movable barriers, two-handed tripping

devices, presence-sensing devices;

semiautomatic feed systems to avoid use of

hands; electrical controls such as interlocks,

emergency stop switches, and ground fault

protection; apparatus for transferring dies;

anti-repeat clutches and magnetic brakes to

prevent inadvertent triggering of power

press or shear; frequent machine inspection;

careful maintenance; special handtools for

feeding pieces into the machine

duction equipment, to non-destructive testing of

finished products. Injury risk is high to the eye,

head, foot, trunk, and limbs.

Injury prevention depends on proper design of

the job, good work practices, and personal protective equipment (table 6-6). Bums are prevented

by spark shielding, special clothing, and insulation of electrical cables. Electric shock prevention

methods include shielding, guarding, good work

practices, proper electrical insulation, and maintenance. Eye protection is needed where sparks

and hot metal particles may fly. Fire and ultra-
112 ● Preventing Illness and Injury in the Workplace

violet-energy-resistant clothing is important for

worker protection. Gloves are needed to protect

hands from bums. Welders’ helmets are required

for electric-arc welding.

Preventive Maintenance

Careful attention to the plant, its operations,

and workers is necessary to maintain controls.

Table 6-7 shows a range of maintenance operations required to prevent injury in manufacturing operations. Maintenance of everything from

foundations and footing to electric bulbs can prevent injuries.

Photo credit: Department of Labor, Historical OffIce

This machine will not operate unless both of the

operator’s hands are on the control switches. The

use of “two-handed controls” represents one

method of preventing injuries associated with

power presses and shears

Table 6-6.—Technologies for Preventing Work. Related Injury During Work with Hot Metal In Foundries

Process, Examples of prevention

device, or tool lnjury potential technology available

Handling of materials such Injury from electrical shock, heat, being Ladles equipped with automatic safety locks

as sand, coke, and coal struck by or against, or being caught or brakes; devices to warn when ladles are

between; explosions, vibration, noise; injury being moved; appropriately guarded

to hand and foot, eye, trunk, limbs, or other conveyors for transport of sand and molds

body parts; death from trauma or

asphyxiation

Cupolas, crucibles, ovens Mechanical devices for charging cupolas;

blast gates to prevent injury from gas

explosion

Production equipment Venting molds to prevent explosions; twohand controls for molding and core-blowing

machine operators; dust-tight sandblast

rooms; guards, two-handed tripping controls

for forging hammers, presses, and upsetters;

careful and frequent equipment inspection

Personal protective equipment, as required,

including hard hats, gloves, leather aprons,

steel-toed shoes, metatarsal guards, safety

glasses, goggles, flame-retardant clothing;

devices to prevent doors and other movable

parts from hitting workers; material-handling

devices to eliminate heavy lifting and

possible spills or splashes of solids and

liquids

SOURCE (322)
—

Ch. 6–Technologies for Controlling Work-Related Injury ● 113

Table 6-7.—Technologies for Preventing Work-Related Injury Through Maintenance of Structures

Process, Injury or illness Examples of prevention

device, or tool potential technology available

Foundations

Structural members, walls,

floors, roofs, and canopies

Stacks, tanks, and towers

Platforms and loading

docks

Sidewalks and driveways

Underground utility repair

and maintenance

Lighting systems

Stairs and exits

Grounds maintenance

Injuries and fatalities from building

collapse

Injuries and fatalities from plant building

collapse

Injuries and fatalities from structural

collapse; asphyxiation and acute poisoning

from tank gases; injuries from explosions

during tank cleaning or repair

Injuries from slips and falls

Injuries from slips, falls, or collision with

moving vehicles

Injuries and fatalities related to sewer gas

explosion; asphyxiation from oxygen

depletion; injuries or fatalities from

collapsed trenches; drowning or injury from

failure of underground pipelines

Cuts from broken bulbs; injury from electric

shock, fails, or poor illumination

Injuries from slips and falls; injuries

crowding in emergency situations

from

Injury from grounds maintenance; cuts

from mower blades and snow throwers; eye

injury from frying objects; collapse from

quick-acting pesticides

Check for and repair settling footings and

columns, cracked foundations

Check for and repair settling walls, defective

columns, joists, beams, and girders; cracked

building materials such as steel, concrete,

wood; cracked walls and windows; sagging

or rotted roofs and ceilings; rotted, sagging,

cracked floors

Place railing around edges of platforms;

check structural integrity; use proper

procedures for maintenance work

Use metal protectors on edges of concrete

platforming; check surfaces for rotting,

holes, or other hazards

Repair damaged sidewalks and motorways;

install and maintain warning signs and

markings

Test for gases and oxygen deficiency before

attempting maintenance work in

underground tunnels and sewers; provide

contaminant-free ventilation during

maintenance work; slope trenches at angles

to prevent collapse

Provide proper equipment for disposal of

burned-out lamps; use properly designed

ladders and platforms; clean and replace

burned-out bulbs on a regular schedule

Install and maintain adequate handrails,

illumination, and walking surfaces on stairs;

keep passageways and stairs free for exit;

install unobstructed exit doors for fire and

emergencies

Maintain tools and equipment; provide

guards for belts, chains, and other moving

parts

SOURCE: (322)

FIRE AND EXPLOSION PREVENTION

Fire and explosions levy an enormous cost on

industry and continue to cause many deaths and

injuries among workers and the general public.

Of fire-related deaths, 75 percent are due to inhalation of smoke and toxic gases and the other

25 percent to direct flame. Injury and death from

fires can be prevented by proper design and construction of buildings, vigilant inspection, early

detection and warning, and appropriate control

methods.

Building designers play an important role in fire

prevention. Engineers and architects can anticipate fire problems in the design of buildings and

facilities and thereby protect workers and the public from injury. A study of over 25,000 fires between 1968 to 1977 resulted in a listing of ignition sources ranging from the most common—

electrical ignition and arson—to the least common—lightning (table 6-8). These findings point

to areas where controls are most needed and on
114 ● Preventing Illness and Injury in the Workplace

Photo credit OSHA, Office of Information and Consumer Affairs

The hazards of hot metalworking are found in steel mills and foundries

Table 6-8.—Common Ignition Sources of Industrial Fires

Frequency

Source (percent) Means of prevention

Electrical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Design and maintenance

Incendiarism (arson). . . . . . . . . . . . . . . . . . . . . . . 10 Security

Smoking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Supervision, substitution

Hot surfaces . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Design and maintenance

Friction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Design and maintenance

Overheated materials . . . . . . . . . . . . . . . . . . . . . . 7 Work practice and control

Cutting and welding . . . . . . . . . . . . . . . . . . . . . . . 7 Work practice

Burner flames . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Design and maintenance

Spontaneous ignition . . . . . . . . . . . . . . . . . . . . . . 5 Housekeeping

Exposure (fire from adjacent property) . . . . . . . 4 Design

Combustion sparks . . . . . . . . . . . . . . . . . . . . . . . 3 Design

Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Design and other

Mechanical sparks . . . . . . . . . . . . . . . . . . . . . . . . 2 Housekeeping

Molten substances . . . . . . . . . . . . . . . . . . . . . . . . 2 Work practice and maintenance

Static sparks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Design (grounding)

Chemical action . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Work practice

Lightning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Design (grounding)

 of that cigarettes to burn for longer times would reduce the number Of cigarette-caused that

kill 3,000 Americans annually.

SOURCE: (322).
Ch. 6–Technologies for Controlling Work-Related Injury 115

Photo credit OSHA Office of Information and Consumer Affairs

An explosion at this oil refinery killed 3 workers and injured 14 others

which building codes and standards tend to concentrate for prevention.

Local building codes and OSHA standards,

generally based on National Fire Protection Association Codes, provide the minimum basis for firesafe construction design. The NFPA Life Safety

Code is an appropriate design guide for warning

and exit requirements.

Since electrically started fires are the most frequent type, appropriate sections of the OSHA

standards and the National Electrical Code of the

NFPA are to be followed for proper installation

and maintenance of electrical equipment. Sparking can occur when unwanted metal objects enter machinery. Particular attention should be

given to preventing heat-generating short circuits

and arcs, two of the leading causes of electrical

fires. Temporary and makeshift wiring when existing electrical outlets are overextended to accommodate a growing office computer system, for example, is one potential source of fire. Improperly

insulated portable electric tools and extension

cords should be avoided. Proper grounding is essential for preventing electrical shock and firecausing arcing.

Smoking, friction, and open flame devices are

other sources of work-related fires that can be

controlled. Smoking should be prohibited in all

but approved areas to prevent fire. Friction from

improperly maintained machinery can cause fires.

These can occur in workplaces where organic dust

may accumulate, such as grain elevators, textile

mills, and woodworking mills. Open flame devices used in industry are frequent causes of fire,

These include heating torches and welding and

cutting equipment. Many fires occur in plants

where housekeeping is lax. Accumulations of oily

rags, waste, and other combustible refuse can ignite unless kept in air-tight noncombustible containers. Compliance with local ordinances concerning incineration, sewage, and other means of

waste disposal provides a minimum of safety.

A designer, engineer, manager, or worker who

knows the identity of combustible hazards can

choose the proper emergency equipment to deal

with fires. Table 6-9 is the fire classification developed by the National Fire Protection Association that relates to the decal identifying most fire

extinguishers. Clearly, placing the appropriate extinguisher in the right place is necessary.

Giving early warning of fires, extinguishing a

fire at early stages, and quickly clearing buildings

are also obviously essential to prevent injury. Design should include early warning and alarm sys-
116 ● Preventing Illness and Injury in the Workplace

Table 6.9.—National Fire Protection Association Fire Classification

Class Description Means of control

A. Fires occurring in ordinary material such as Cooling and quenching by water to reduce heat is

wood, paper, etc. recommended. Special dry chemicals may be used to control

flame.

B. Fires that occur in the vapor-air mixture over Since water tends to spread such fires, dry chemicals, carbon

the surface of flammable liquids such as dioxide, foam, or halogenated agents are preferred.

gasoline, oil, etc.

c . Fires that occur in or near equipment using Non-conducting agents such as dry chemical or carbon dioxide

electrical energy. must be used to extinguish to prevent electric shock.

D. Fires that occur in combustible metals such as Since ordinary means of control such as water may increase

magnesium, lithium, potassium, etc. the intensity of such fires, special equipment and materials

are required to control this tvpe of fire.

. r –

SOURCE (322)

terns. Both manual and automatic fire extinguishing systems should be strategically located to limit

fires in their early stages. Fire-safe stairwells, adequate aisle space, and appropriate stairwell width

are essential for safe and rapid exit. Emergency

stairwell lighting should be provided.

The use of fire-resistant materials, the design

and construction of building frameworks, ventilation systems, concealed spaces, storage areas, exteriors, fuel sources, and building uses—all part

of the designer’s functions—make a difference.

Widespread use of masonry in the interiors of European dwellings is thought to be a factor in their

superior fire record. Plastic interiors used in this

country, on the other hand, are the source of

deadly toxic gases during fires.

Explosions are a special preventive concern of

designers. Explosive atmospheres result from the

accumulation of organic dusts and from gases and

vapors. The U.S. Department of Agriculture lists

133 dusts by degree of explosibility (322). Dusts

produced from phenolic, urea, vinyl, and other

synthetic resins and powders used in the plastics

industry also explode under certain conditions.

The Explosion Venting Guide of the NFPA provides specifications for buildings where the risk

of explosion is high.

Explosion prevention can be accomplished by

inert gas systems that displace oxygen so that

gases and dusts are incombustible and by adequate ventilation, proper process operation, and

vigilant maintenance. Gas lines and valves should

be inspected frequently for leaks.

Since three-fourths of fire-related deaths are

from toxic fumes and since industrial fires may

involve extremely toxic materials, it is important

for firefighters to be able to identify chemical and

material inventories in establishments under their

jurisdiction. Several municipalities and States

have developed systems for this. The OSHA hazard communication (labeling) standard may also

be useful for this purpose.

INJURY CONTROL PROGRAMS IN INDUSTRY

Effective control of work-related injury depends

in part on how well a company is organized to

deal with it. Management has the primary responsibility for prevention. Relevant programs include

training workers, supervisors, and managers to

recognize workplace hazards and take steps to

control them (see ch. 10).

Successful injury prevention must start with a

strong commitment from management. The

stronger the commitment at the top the greater

the likelihood of success. Typical management

programs for preventing work-related injury (and

illness) include:

. establishing clearly stated company policies

for prevention;

• avoiding work-related injury and illness by

planning ahead when designing new plant or

modifying existing processes;
.

Ch. 6–Technologies for Controlling Work-Related Injury ● 117

● analyzing each hazardous operation to de- ●

termine the steps required to do the job without causing injury or illness; ●

. identifying hazards through workplace surveys and investigating the factors surrounding an event that caused or nearly caused in- ●

juries or illnesses;

maintaining accurate and complete records

of the causes of injuries and illnesses;

training workers, supervisors, and managers

to identify hazards and prevent injury and

illness that could result from them; and

placing and maintaining people in jobs suitable to their physical status.

THE DU PONT INJURY CONTROL PROGRAM

Perhaps the best source of information about

how to run an injury-control program is available from the successful companies. Determining

one best program is impossible, of course, for

hazards vary from industry to industry, plant to

plant, and department to department, making

comparisons of overall rates difficult. This section focuses on the Du Pont Company not because

its program is best, but because it is good enough

that Du Pont sells it to other companies and much

information is available about it. Du Pont plants

have very low injury rates, which have dropped

dramatically since 1912, falling even more than

the all-industry average according to National

Safety Council data. A key to the company’s success in preventing injuries at work is its commitment in this area. Its program consists of four

main parts:

. establishing injury prevention as a top management objective;

● establishing injury prevention as a line-management responsibility;

● adopting an injury-control philosophy to

guide management action; and

. establishing an organization for injury

control.

Du Pent’s success in preventing injuries may

largely be attributed to strong commitment of top

management. The founder of the company was

personally committed to preventing injury among

his workers, often family or friends, who were

in the high-risk business of manufacturing gunpowder.

els of management is partly dependent on success

in preventing injury. Du Pont lists the following

as incentives for making injury control a management objective:

● protect workers,

● improve profits,

● improve product quality,

. improve productivity,

. improve employee-management relations,

and

● comply with OSHA regulations.

Du Pont finds that injury control increases profits. Using National Safety Council statistics for

1976, Du Pont estimated the average cost of each

disabling injury to be $7,182. The company then

compared its estimated costs for 1977 (based on

their rate of 0.2 disabling injuries per million hours

worked) with the projected cost if the rate had

been at the all-industry level of 10.87. Table 6-

10 shows Du Pont’s estimated savings were greater

than $15 million, based on the all-industry injury

rate; a more representative comparison, however,

would be with large chemical companies, which

as a group have lower injury rates than the allindustry average. Nevertheless, Du Pont’s own

comparisons were impressive enough to be featured in a Fortune article about savings from preventing work-related injury (284).

Line-management emphasis on preventing injury is another critical element of success. Responsibility for preventing injury is as much a condition of employment in Du Pont as getting the job

done, High-level staff meetings often begin with

Commitment to injury prevention still perme- reports of job injuries, and any fatality has first

ates this Fortune 500 corporation from the top priority at any management meeting, including

down. For example, performance rating at all lev- the presidents.
118 ● Preventing Illness and Injury in the Workplace

Table 6-10.–Du Pent Calculations of Cost Savings From Injury Control

Du Pont U.S.A. Totals if at all

actual (1977) industry rate (1976)

Disabling injuries/million worker-hours. . . . . . . . . . . . 0.20 10.87

Disabling injuries/year . . . . . . . . . . . . . . . . . . . . . . . . . . 2,174

Average cost/injury. . . . . . . . . . . . . . . . . . . . . . . . . . . . . $7,182 $7,182

Cost/year (total injuries) . . . . . . . . . . . . . . . . . . . . . . . . $287,280 $15.613.668 . ,

SOURCE: (156)

Five basic beliefs underlie Du Pont’s program:

●

●

●

●

●

all personal injuries can be prevented,

managers and supervisors must personally

accept their responsibilities to prevent personal injuries,

reasonable safeguards are possible for all construction and operating exposures that may

result in injury,

efficiency and economy are enhanced when

personal injuries are prevented, and

all employees must be trained to understand

the advantages to them, as well as to the

company, of taking responsibility to prevent

personal injuries.

Du Pont’s Safety Training Observation Program (STOP) uses programed self-study courses

to enhance injury prevention. It is one of more

than 200 vocational courses developed for industrial craft skill training. The objective of STOP

is to train line managers to notice workplace conditions that might lead to an injury or illness.

STOP presents seven broad categories that are

suggested for observation rather than having deSUMMARY

Perhaps because of the more obvious sources

of injury as compared to illness, safety engineering appears to be more pragmatic than industrial

hygiene. Engineers have, to some extent, directed

their attention to sources of hazard such as electricity, falls, and fires, and produced codes and

standards for good practice.

tailed checklists of hazardous working conditions.

The manager looks for injury potential associated

with procedures, tools, equipment, orderliness,

personal protective equipment, positions of people, and actions of people. A training unit divided

into eight parts is used for instruction and includes

pocket-size cards to record workplace observations as practice between teaching units.

The administrator of the course is key to its effectiveness. To show management commitment

to the course and to motivate supervisors to be

equally committed, the administrator must be

highly placed in the management structure.

The desired outcome of the training, which

should take only 12 to 16 hours away from work,

is supervisors who are able to recognize hazardous conditions, to assign responsibility for correcting it, and to ensure the elimination of the

hazard. The success of the program has been

measured through reduced injury rates in firms

that have purchased and used the training program from Du Pont.

These codes and guides to good practice appear

often to be based on the personal experience and

judgment of the practitioners who happen to write

safety textbooks or are members of the committees who write the codes. This field has relied on

experience and judgment instead of scientific analysis, systematic data collection, the application
Ch, 6–Technologies for Controlling Work-Related Injury . 119

of epidemiologic techniques, and experimental research. It is probably fair to say that up to the

present there has been little that might be called

a “science” of safety. In addition, as described in

chapter 4 on the identification of injury hazards,

the attempt to attribute most injuries to so-called

unsafe acts has often diverted attention away from

the design of plant and equipment that can prevent “unsafe acts” or minimize the adverse consequences of “unsafe acts. ” However, it is unclear

what differences a more theory-based rather than

the pragmatic approach would have made.

Several specific areas where injury control can

be applied were discussed in this chapter. A number of different methods and technologies are

available for preventing injuries related to motor

vehicles, construction activities, manufacturing

processes, and fire and explosion hazards. These

include the proper planning of plant sites and the

design of equipment, as well as the use of guards,

personal protective equipment, and appropriate

work practices. Adequate attention to preventive

maintenance, and the training of workers and

managers, also play roles in injury prevention.

Successful injury control programs start with a

strong commitment to injury prevention at all

levels of management.

Controls are known for many hazards. However, they are not always used because they were

not built into a plant, are not available at a particular worksite, or are pushed aside to get the

job done. All of these reasons for not using controls emphasize the important role of management

in providing controls and seeing that they are

used.
7.

Ergonomics and Human Factors
.’

.

.

Figure

7-1.

7-2.

7-3.

7-4*

7-5.

7-6.

7-7.

7-8,

7-9.

“ 7-1o.

139 ‘

Page .

127

137-

138

LIST OF FIGURES

I No.

Schematic Representation of a Man-Machine System . . . . . . . . . . . . . . .

Control Burner Arrangements of Simulated Stove Used in Experiment

About Logical Arrangements . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . . . . .

Major Nerves in the Arm and Hand . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

The Carpal Tunnel . . . . . . . . . . . . ● ● ● + ● ● . . ● ● ● ● . . . . , . ● . ● . . . ● ● . ● . . . ,, .

Flexion and Extension of the Wrist . . . . . . . . . . . . . . . . . . . . . ● .

Job Analysis: Assembly Tasks . . . . . . . . . . . . . . . . . . . . . . . ● . . ● ● ● ,1 ●

. * . . . . . . . . . . Good and Bad Designs for Containers and Workbench- . . . . . . . . . . .

Good and Bad Designs for Powered Drivers. . . . . . . . . . . . . . . . . . . . . . .

A Knife Designed to Reduce Cumulative Trauma Disorders in

Poultry Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Potential Ergonomic Risk Factors Associated with VDT Design ... , . .

Page

1 . . . 124

. .* 125

.** 129

● . . 130

. . . 130

● . . 132

. . . 133

#..‘ 134

. . . 135

. . . 137

.
— —

7

Ergonomics and Human Factors

Neither workers, nor machines, nor workplaces

exist apart from each other. To accomplish work,

all come together, and injuries and illnesses sometimes result from their interactions. The study of

these interactions is called “ergonomics,” or “human

factors engineering. ”

The term ergonomics was coined in the United

Kingdom after World War II to describe a discipline created during the war. It had been noted

that “bombs and bullets often missed their mark,

planes crashed, friendly ships fired upon and

sunk, and whales were depth charged” (471). In

response to this situation, research on designing

military equipment to match more closely the capacities of the users began on both sides of the

Atlantic. Attention was thus devoted to the interaction between the human operators and their machines.

One name for this new discipline, ergonomics,

is derived from two Greek words, ergo, meaning

work, and nomos, meaning laws. Ergonomics is

the science devoted to understanding the laws or

principles that govern the design of work systems.

A British professional group—the Ergonomics Research Society—was formed by the practitioners

of this new discipline. An organization with similar aims, the Human Factors Society, was founded

in the United States in 1957. The work of the

original members was termed “human factors

engineering, ” or engineering psychology. Whether

they are called human factors engineers or ergonomists, the scientists who practice this discipline

draw on a number of other disciplines, including

medicine, physiology, psychology, sociology,

engineering, and physics.

Ergonomists are concerned with safety, effectiveness, and efficiency wherever people are part

of a system (380). The discipline is “an applied

science concerned with the design of facilities,

equipment, tools, and tasks that are compatible

with the anatomical, physiological, biomechanical, perceptual, and. behavioral characteristics of

humans” (250). The principle behind ergonomic

design is that the machine should fit the worker,

rather than forcing the worker to fit the machine.

To quote from one ergonomics guide (655):

Man’s physical limits for bending, stretching,

and/or compressing are such that the machine

must be made to adapt to the man rather than the

converse. Behavior characteristics are somewhat

more flexible. Man can adjust his sensory-motor

behavior to some degree, and . . . can utilize

alternate procedures and make up for certain

equipment inadequacies. However . . . as operator load increases due to task complexity, fatigue

may reduce operator reliability; system performance could degrade at a critical time . . . Workplace layout should favor the man’s physical and

behavioral capability in all cases in which a likely

error in human performance could affect . . .

safety . . , The designer cannot assume that personnel selection and training will be a panacea for

improper workplace considerations.

Figure 7-1 is a schematic representation of a

human-machine system. The person processes information about the environment and acts on it

by using the machine’s controls. The important

features of the machine include the controls used

by the worker, the operations of the machine, and

the displays used to feed information back to the

worker. The task of the ergonomist is to analyze

how the worker obtains the information needed

to operate the machine, how that information is

processed to reach a decision concerning the

appropriate way to control the machine, and what

worker actions are appropriate to control the machine in a fashion that is safe and meets production criteria (380).

Other considerations, especially improving the

productivity of workers, fit easily into the goals

of ergonomics. Opportunities exist for workplace

designs that simultaneously improve production

output and reduce the risks of injury. For instance,

C. G. Drury reported that new handtools in the

component-assembly department of a large com123
124 . Preventing Illness and Injury in the Workplace

puter company and changes in seating, lighting, and savings, and the number of rejected compoand workbenches led to improved production and nents fell to half the previous level. The workers

the elimination of repetitive motion injuries. The involved expressed increased satisfaction with

costs of the redesign” were earned back 4.3 times their jobs (340).

within one year through increased productivity

Figure 7-1.—Schematic Representation of a Human-Machine System

SOURCE (292)

CLASSIFICATIONS OF ERGONOMICS

Ergonomists usually subdivide the field into information ergonomics and physical ergonomics.

Information ergonomics is concerned with the collection, display, sensing, and processing of information. Physical ergonomics is concerned with

worker size, strength, capabilities for motion, and

working posture.

Ergonomists use a number of techniques that

include the evaluation of the transmission of information between the machine and the worker

(link analysis), discovery and evaluation of system failures (critical incidence analysis), detailed

examination of the sequence of actions taken by

workers (task analysis), and analysis of situations

that may arise from unprogrammed events or human errors (contingency analysis) (380). Ergonomists also make extensive use of anthropometric

data concerning the physical dimensions and capabilities of the human population. In addition,

the techniques of biomechanical analysis are used

to measure expected physical stresses encountered

by parts of the body while performing; work tasks.
Ch. 7—Ergonomics and Human Factors 125

Information Ergonomics

Information ergonomics is generally concerned

with what the worker senses in the workplace and

how that information is processed by the worker,

The two major sources of sensory information are

visual and auditory.

Visual displays in the workplace include meter scales, control labels, warning signs, cathoderay tube (CRT) displays, and printed text. To this

list can be added video display terminals (VDTs),

which can be CRT displays, liquid crystal displays, or other technologies. Three factors important to the operator must be considered in designing a visual display: the size of the critical detail

in the display, its brightness, and the contrast of

the display against the background. There are a

number of techniques available to achieve these

goals in design and to evaluate existing equipment.

There are also many guidelines for special applications, including the special needs of groups such

as older workers (23).

Workers also receive information through

sound. These can include tones (bells, whistles,

beepers, etc. ) as well as speech. Designers and

ergonomists often face the question of whether

to provide information through visual or auditory

means. In general, if the message is simple, short,

or calls for immediate action, if the worker is

already overburdened with visual messages, or

if the workplace is too dark or too bright for

visual displays, an auditory presentation is recommended. If the message is complex, long, and

does not necessitate immediate action, or the

auditory system of the worker is already overburdened, or if the workplace is too noisy, a

visual display may be preferred (23).

Finally, information ergonomics is concerned

with the processing of information by the worker

and the design of the workplace, including the design of controls. Research that has measured the

abilities of humans to accurately process information has shown that people often will not be

able to make quick, accurate responses in complex or unexpected situations, Second, the studies

have also shown that “compatibility” in displaycontrol design is very important. Compatibility

refers to the relationships between stimuli and responses, and generally falls into three categories:

spatial (the compatibility of physical features or

spatial arrangement for displays and controls),

movement (the direction of movement of displays

and controls), and conceptual (the associations

people hold concerning the meaning of signals,

such as in the United States the association of the

color green with “go”) (292).

One example of an everyday problem in compatibility will perhaps clarify this notion. Figure

7-2 presents four possible arrangements of the

burners and burner-controls for a stove. For several of these patterns, the relationships between

burners and controls can be difficult to learn and

hard to remember because the arrangements lack

spatial compatibility. To examine this, researchers in the 1950s setup an experiment in which they

told a group of subjects to turn on specific burners.

The subjects’ reaction times were measured and

the number of errors was noted. Design I, assoFigure 7-2.–Control Burner Arrangements of

Simulated Stove Used in Experiment About

Logical Arrangements

I

I II

I

Ill

I

Iv I

Number of errors in 1,200 trials:

arrangement

1 0

II 76

Ill 116

IV 129

SOURCE: (292)

I
126 . Preventing Illness and Injury in the Workplace

ciated with both the fewest errors (zero) and the The cherry-picker accident discussed in box C ilbest reaction time, was considered to be the most lustrates the importance of controls layout.

compatible (292).

Physical Ergonomics Many workplaces have dozens of incompatible control configurations, which often lead to Physical ergonomics, concerned with the worker

operator errors and subsequent serious injury (23). as a physical component of the work process,
—.

Ch. 7—Ergonomics and Human Factors ● 127

often uses the techniques and equipment of anthropometry and biomechanics. Anthropometry

is the measurement of the physical dimensions of

the human body, including both the structure of

the body in fixed positions and the extent of movement possible, such as reach or lifting capacity.

Biomechanics is the study of the mechanical

operations of the human body. The muscles,

bones, and connective tissue can be analyzed as

a mechanical system using the fundamental laws

of Newtonian mechanics. The forces acting on the

muscles, bones, joints, and spine can be determined for the lifting of an object, for instance.

Through such analysis, it is possible to calculate

the size and direction of forces acting on the body.

These can be compared with expected human tolerances to judge whether the activity in question

will cause harm.

ERGONOMICS AND PREVENTION OF MUSCULOSKELETAL INJURIES

Ergonomic principles can be applied to prevent

both overt and cumulative traumas. An example

in the overt category is the risk of falling from

a ladder, which can be reduced by considering the

sizes and mobility of people when deciding how

far apart to place a ladder’s rungs (250). Cumulative traumas are not the result of single events

or stresses; they stem from the repeated performance of certain tasks. Back problems are by far

the most common cumulative trauma injuries.

Evaluation and redesign of tasks to prevent back

injuries is discussed later in this chapter.

Repetitive motion disorders are a type of cumulative trauma associated with repeated, often

forceful movements, usually involving the wrist

or elbow. Some 20 million workers on assembly

lines and in other jobs that require repetitive,

strain-producing motions are at increased risk of

developing such disorders. Redesigning work stations, equipment, and handtools can significantly

reduce the awkward, forceful movements common to many jobs on assembly lines, in food processing, in the garment industry, and in offices.

Carpal tunnel syndrome, one of this class of

disorders, illustrates the potential for prevention

offered by the integration of ergonomics, medical surveillance, and treatment.

Carpal Tunnel Syndrome

A wide variety of workers (see table 7-I), from

aircraft assemblers to upholsterers, are among

those at risk for carpal tunnel syndrome (CTS),

a progressively disabling and painful condition

Table 7.1.—Occupations and Activities Associated

With Carpal Tunnel Syndrome

Aircraft assembly

Automobile assembly

Buffing

Coke making

Electronic assembly

Fabric cutting/sewing

Fruit packing

Gardening

Hay making

Waitressing

Housekeeping

SOURCE (60)

Inspecting

Meat processing

Metal fabricating

Musicians

Packaging

Postal workers

Textile workers

Tire and rubber workers

Typing

Upholstering

of the hand. Because the musculoskeletal strain

from repeatedly flexing the wrist or applying armwrist-finger force does not cause observable injuries, it often takes months or years for workers

to detect damage.

The incidence and prevalence of CTS in the

work force is not known. The National Institute

for Occupational Safety and Health (567) reports

that 15 to 20 percent of workers employed in construction, food preparation, clerical work, production fabrication, and mining are at risk for

cumulative trauma disorders. The Bureau of Labor Statistics (603) reports 23,000 occupationally

related repetitive motion disorders in 1980, although the number of CTS cases is not specified.

CTS is undoubtedly underreported in aggregate

statistics. Research in particular high-risk plants

provides some insight into the extent of the problem. In a study at an athletic products plant, 35,8

percent of workers had a compensable repetitive

trauma disorder. In some jobs within the plant,
128 ● Preventing Illness and injury in the Workplace

Photo credit: OSHA, Office of Information and Consumer Affairs

Work on an automobile assembly line can involve cramped working positions. A Volvo assembly plant in Kalmar,

Sweden, uses “tipper trolley s.” These trolleys hold the automobile bodies and can be tipped 90 degrees to allow

work on the underside of the car

the rate was as high as 44.1 percent, and carpal

tunnel syndrome occurred in 3.4 percent of the

workers (21,23). Many industries claim that the

incidence of CTS is increasing and is one of their

most disabling and costly medical problems (60).

Symptoms

The onset of symptoms of CTS is usually insidious. Frequently, the first complaint is of attacks of painful tingling in one or both hands at

night, sufficient to wake the sufferer after a few

hours of sleep. Accompanying this is a subjective

feeling of uselessness in the fingers, which are

sometimes described as feeling swollen. Yet little

or no swelling is apparent. As symptoms increase,

attacks of tingling may develop during the day,

but the associated pain in the arm is much less

common than at night. Patients may detect changes

in sensation and power to squeeze things but some

people suffer severe attacks of pain for many years

without developing abnormal neurological signs.

Ultimately, in advanced cases, the thenar muscle

at the base of the thumb atrophies, and strength

is lost.

Compression of the median nerve is the immediate cause of CTS. The median nerve comes

down the arm, through the wrist, then branches

in the hand, supplying the thumb, forefinger, middle finger, and half the ring finger with nerves (fig.

7-3). The carpal tunnel itself, located in the wrist,

is formed by the concave arch of the carpal bones

and is roofed by the transverse carpal ligament

(fig. 7-4). These structures form a rigid compartment through which nine finger tendons and the

median nerve must pass. Any compromise of this

unyielding space usually compresses the median

nerve.

Risk Factors

Repetitive motions, such as those required in

many jobs, is one of a number of risk factors for

CTS. It is probably the most readily controllable

cause, however. Certain diseases, acute trauma,

congenital defects, wrist size, pregnancy, oral contraceptive use, and gynecological surgery all may

contribute to the likelihood of developing CTS.

Overall, the incidence of CTS is higher in women

than in men, perhaps because of some of these

risk factors.

Occupational tasks responsible for the development of CTS include physical exertions with

certain hand postures or against certain objects,

and exposures to vibration or cold temperatures.

Repeated and forceful up-and-down motions of

the wrist (flexion and extension) (fig. 7-5), cause

the finger tendons to rub on the structures forming the carpal tunnel. This constant rubbing can

cause the tendons to swell (tenosynovitis), eventually putting pressure on the median nerve inside the carpal tunnel. The nerve itself is stretched
Ch. 7—Ergonomics and Human Factors . 129

Figure 7-3.—Major Nerves in the Arm and Hand

Pal mar

(a)

(b)

SOURCE (60)
130 . Preventing Illness and Injury in the Workplace

Figure 7-4.--The Carpal Tunnel

Median nerve

Finger flexor

SOURCE (60)

Figure 7-5.— Flexion and Extension of the Wrist

a.

Bending the wrist causes the finger flexor tendons to rub on

adjacent surfaces of the carpal tunnel.

SOURCE’ (60)

Flexor retinaculum

(transverse carpal ligament)

by repeated exertions, and compressed between

the walls of the carpal tunnel.

Forceful movements and the direction of the

movement are only two of the underlying causes

of tenosynovitis that can lead to CTS. The speed

of movements and incorrect posture while working also are important (275). Median nerve compression also can be caused by tasks that require

a sustained or repeated stress over the base of the

palm (247). Examples include the use of screwdrivers, scrapers, paint brushes, and buffers.

Although the mechanism is not yet understood,

low frequency vibration is a recognized risk factor for CTS (405). Vibration exposure may result

from air- or motor-powered drills, drivers, saws,

sanders, or buffers. Cannon (95) examined medical records at an aircraft company and found a

strong association between CTS and use of vibrating tools.

Control of CTS

Control of CTS requires a two-pronged approach. The primary strategy to prevent cases is

the use of ergonomic principles to modify handtools and to improve work-station design and
Ch. 7—Ergonomics and Human Factors 131

work practices. Even a successful ergonomic program will not prevent all cases of CTS, however.

The second important element, therefore, is a

medical surveillance program. This is particularly

important now when so little is known about the

individual factors that cause some people to develop CTS. Thus far, no programs focusing on

the medical evaluation of CTS seem to exist (60).

Ways are needed to identify the earliest sign of

CTS, to evaluate progression of the disease, and

to examine the role of predisposing risk factors.

The purpose of such a medical surveillance program is prevention of advanced disease by instituting therapy at early stages.

Although medical surveillance for CTS is still

in very early stages, ergonomic interventions have

been remarkably successful where they have been

instituted. Armstrong (21) describes the steps involved in developing appropriate controls. First,

plants and specific departments within plants in

which there is a documented high rate of CTS

should be identified. Then each job should be

systematically analyzed. Traditional time-andmotion studies, in which each movement or act

is recorded, can be used. Each element of the job

can then be checked against factors known to be

associated with CTS development. These include

posture of the hand and wrist, strength, stress concentrations over the palm, vibration, cold temperature, and the presence of gloves.

Armstrong presents a typical work task as an

example. Figure 7-6 shows a worker taking parts

out of a container and placing them on a conveyor. The six elements involved in this task are

reach, grasp, move, position, assemble, and release. Reaching into the container involves wrist

flexion and pinching, during which the worker’s

wrist is likely to rub on the edge of the box. The

forearm is also likely to rub on the edge of the

work bench while the part is positioned. The redesigned work station should reduce stress on the

hand and wrist, and eliminate sharp edges. Good

and bad designs for the container and the workbench with jig in this hypothetical case are illustrated in figure 7-7.

Powered handtools can also be designed and

used to minimize stress. As illustrated in figure

7-8, good designs allow the work to be done with

little or no flexion or extension of the wrist.

Armstrong and his colleagues have investigated

cumulative trauma disorders in a poultry processing plant using the procedures described above.

They discovered that workers in the “thigh boning” section had the highest incidence of cumulative trauma disorders of all departments. Thigh

boning involves grabbing the thigh with one hand

on a moving overhead conveyor, then making

four cuts with the other to separate the meat from

the bone. Each worker makes an estimated 15,120

cuts per shift. Ergonomic improvements to the

process recommended by Armstrong and colleagues include training workers in the “proper

work methods and knife maintenance to minimize

the time and, hence, the distance that must be

reached and force that must be exerted on the

thigh.” The work station could be modified to

minimize the distance to be reached. The workers wear wire mesh gloves with rubber gloves

underneath, which increase the force necessary

to grasp the thigh and pull the meat away. Gloves

should fit well, and the addition of barbs on the

palm of the wire mesh glove might facilitate the

hand actions. A new knife handle design, to reduce the force required to hold the knife and make

the cuts—e.g., that pictured in figure 7-9—is suggested (22). Such a design would also minimize

wrist flexion.

A high incidence of repetitive trauma disorders,

including carpal tunnel syndrome, in a telephone

assembly plant prompted management to consider

how to prevent future cases. McKenzie and colleagues (299) noted the highest rates in areas using

vibratory air screwdrivers, and in jobs requiring

repetitive grasping, squeezing, or clipping motions. Ergonomic changes recommended included

modifying the screwdrivers with sleeve guards and

changing work positions to minimize hand and

wrist stress. The changes were instituted with

almost immediate results: from 2.2 percent annual

incidence of repetitive trauma disorders in 1979
132 . Preventing Illness and Injury in the Workplace

Figure 7-6.-Job Analysis: Assembly Tasks

Job analysis

1. Reach for part - 2. Grasp part

.

4. Position part i

5. Assemble part

• Assembling parts on a moving conveyor can be described by a series of six elements,

SOURCE (21)

to 0.79 in 1981. Lost and restricted workdays fell

from 5,471 in 1979 to 1,111 in 1981, and further

reductions were expected in subsequent years.

Back Disorders

The Bureau of Labor Statistics completed a survey of workers who had incurred back injuries

while lifting, placing, carrying, holding, or lowering objects (605). Of the 900 workers included in

the tabulated results, more than 75 percent were

lifting at the time of the injury, Surprisingly, the

back injuries were concentrated in younger workers; almost 75 percent occurred in 20- to 44-yearolds. Both the weight and the bulkiness of the

lifted objects were often associated with injuries.

About half the injured workers had received some

instruction about proper lifting.

Manual lifting presents a risk of overexertion

injuries and cumulative damage to the soft tissues

around the spine. Overexertion injuries to the

back constitute the largest single category of

workers’ compensation claims, amounting to 25

to 30 percent of all disability cases Lower-back

injuries are often extremely painful and significantly diminish the quality of life of the afflicted

workers. Many of these can be prevented by job

and equipment redesign.

The conventional wisdom about how to lift

something is to squat, pick up the object, and,

while keeping the back straight, lift straight up
Ch. 7—Ergonomics and Human Factors ● 133

, a. Container . ’

.

,.

,.

I

edges too high

and too sharp

Side cut out with

rounded edge Elbow height

tilted

Elbow height

edges too high

Containers should be designed so that workers can reach all locations without flexing their wrist. All edges that come into

contact with the worker should be well rounded.

b. Workbench and jigs

Bad Bad

!

Sharp edge of work surface Flat and too high

\ OK OK

. .

Tilted away

sOURCE: (21)
I&! . Preventing Illness and Injury in the Workplace

Figure 7-8.—Good and Bad Designs for Powered Drivers

Powered drivers

OK

Pistol handle

vertical surface

Bad

Pistol handle

horizontal surface

elbow height

OK Inline handle

horizontal surface

OK

Pistol handle

horizontal surface

below waist height

Bad Inline hand

horizontal

surface

below elbow

height

Wrist posture is determined by the elevation and orientation of the work surface with respect to the workers and the shape

of the tool. .-

SOURCE: (21)

with the legs. This procedure is thought to prevent injury to the back. In many cases this procedure is justified, but there are many other situations where it is not.

Work-Load Evaluation

There are at least four basic sets of criteria for

determining acceptable work loads: biomechanical, physiological, psychophysical, and epidemiological (453). Biomechanical criteria are based

on pressures and stress exerted on the body, particularly on the spinal column. Limits of tolerance

have been developed by observing damage to

cadavers when pressure is applied. Physiological

criteria are primarily metabolic, e.g. oxygen consumption and heart rate. The psychophysical

method incorporates workers’ perceptions and

sensations into the assessment of work load for

both static and dynamic strength. Epidemiologic

criteria are derived from aggregate data concerning the incidence, severity, and distribution of low

back pain. These four approaches can be integrated and guidelines established with input from

each. The National Institute for Occupational

Safety and Health has developed recommendations in this way.

Maximum acceptable work loads are often expressed in terms of the weight and frequency of

lifting. For instance, 75 percent of the industrial

male population can lift a 13-kilogram box of

fixed proportions every 5 seconds, and a 34-

kilogram box every 30 minutes without triggering or aggravating low-back injury symptoms.
Ch. 7—Ergonomics and Human Factors ● 135

Figure 7-9.—A Knife Designed to Reduce Cumulative Trauma Disorders in Poultry Processing

One possible knife handle with three blades for reduced wrist deviations. The handle is designed

to reduce the tendency for the knife to fall out of the hand in thigh boning.

SOURCE (22)

There is great practical significance to having compensable back problems. For case histories of

very specific work-load recommendations. They task evaluation and redesign carried out by the

can be used both for determining that a task is Liberty Mutual Insurance Co., see boxes D and

unacceptable and as guidelines for redesigning the E. According to Snook (453), “most industrial

task. Recognition of a problem often occurs only tasks with unacceptable work loads can be modafter a number of compensation claims have been ified for less than the average cost of a single low

awarded, triggering investigation. Insurance com- back compensation claim. ”

panics have a direct incentive to cut down on

APPLYING ERGONOMICS TO VDT DESIGN

The first reports from Europe concerning po- cluded that there were no known radiation

tential adverse health effects associated with video hazards and that the real hazards were ergonomic

display terminals included accounts of many re- problems: musculoskeletal problems, visual probported musculoskeletal and visual problems. Early lems, and fatigue. Poor design of equipment or

U.S. studies of potential VDT hazards also con- poor job design may produce such problems.
136 . Preventing Illness and Injury in the Workplace

Musculoskeletal problems among office workers range from discomfort to pain and medical

disability. The back, neck, and shoulders are the

most frequent sites of problems. Table 7-2 summarizes the results from several studies of VDT

workers. There is general agreement that musculoskeletal problems are associated with poor

working positions, repetitive motions, and the

length of work time without a break.

Figure 7-IO illustrates risk factors contributing

to musculoskeletal problems associated with

Box E.—Ergonomics-Task Evaluation

and Redesign

This case history involves back injuries to

materiaI handlers in the packing department of

a metal office equipment and desk accessory

manufacturer. The six female material handlers

are required to manually lift boxes of various

sizes and weights from a conveyor and stack

them on wooden pallets. There were six compensable back injuries reported between February 1980 and September 1982, with a cost of

$131,415.

Boxed products are transported by belt conveyors to the position of the material handler,

where they are taken off the line and lowered

and/or lifted onto pallets. Due to the wide variety of Sire, shapes, and weights, the boxes

handled vary in weight from a pound to large

bulky boxes weighing 50 pounds. Full pallets are

taken by forklift to a warehouse.

Source: (675}.

VDTs, including equipment design (VDTs, work

stations, and chairs) and job design (constrained

working positions, repetitive work, and inadequate rest breaks). Any of these can be changed.

The keyboards and screens of many early VDT

work stations were fixed relative to each other and

the height of the work station was not adjustable.
Ch. 7—Ergonomics and Human Factors . 137

Table 7-2.—Frequency of Reported Musculoskeletal Problems From Various Studies

of VDT Workers

Percent reporting frequent or daily problemsa

Study/type of worker Neck-shoulder Back Arm-hand

Arndt, 1980:

Telephone operatorb 

. . . . . . . . . . . . . . . . . 8-17 15 12

Service assistant . . . . . . . . . . . . . . . . . . . 9-14 14 6

Accounting clerkb . . . . . . . . . . . . . . . . . . 7-1o 10 5

Laubli, et al., 1980:

Data-entry VDT operator. . . . . . . . . . . . . . 11-15 N.A. 6-15

Accounting machine operator . . . . . . . . . 3-4 N.A. 8

Conversational VDT operator. . . . . . . . . . 4-5 N.A. 7-11

Typist. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 N.A. 4-5

Traditional office worker . . . . . . . . . . . . . 1 N.A. 1

Hunting, et al., 1981:

VDT operator . . . . . . . . . . . . . . . . . . . . . . . 6-12 6-10 6-12

Typist , . . . . . . . . . . . . . . . . . . . . . . . . . . . . , 6-12 6-10 6-10

Traditional office worker , . . . . . . . . . . . . 2-5 2-5 2-5

Canadian Labour Congress, 1982:

VDT operator . . . . . . . ... . . . . . . . . . . . . 10-12 10-15 2-3

Non-VDT operator . . . . . . . . . . . . . . . . . . . 7-8 9-14 4

Sauter, et al., 1983:

VDT operator . . . . . . . . . . . . . . . . . . . . . . . 24-34 27-35 3-4

Non-VDT operator . . . . . . . . . . . . . . . . . . . 19-28 22-29 4-6

 reporting almost frequent, often constant Ranges represent Questions

 33 percent use 

N A = 

SOURCE (25)

Figure 7-10.— Potential Ergonomic Risk Factors Associated with VDT Design

Display

height

keyboard

Iocat ion

Chair

height

Foot

SOURCE (25)
138 ● Preventing Illness and Injury in the Workplace

Equipment can be redesigned and made to fit the

various sizes of people. Many manufacturers now

offer, usually at a higher price, office furniture

and equipment that has been “ergonomically designed. ” Although this equipment has been advertised as being vastly superior to ordinary office

equipment, its biggest advantage from an ergonomic perspective is the simplest—it is adjustable.

Job redesign to reduce repetitiveness and to

alleviate constrained postures is also possible.

Finally, rest breaks can be instituted to reduce

fatigue from working in one position for long periods of time. Rest breaks often result in increased

productivity as well as fewer musculoskeletal

complaints (25).

Visual problems reported among VDT users include eyestrain, burning/itching eyes, blurred vision, double vision, color fringes, and deterioration of acuity (table 7-3). A recent review by a

National Research Council panel (321) concluded,

however, that there was no evidence that the use

of VDTs led to visual system problems different

from symptoms reported by workers engaged in

other tasks involving intensive close work.

The problems reported are related to the visual

demands of VDT work. The intensity and duration of visual demands, the quality of the VDT

image, and illumination are important. VDTs

have often been manufactured and introduced in

workplaces without sufficient attention to the

these factors. The National Research Council (321)

report notes that “[i]n many instances . . . VDTs

have been designed without attention to existing

scientific data on image quality, and many VDTs

on the market do not provide the legibility of

high-quality printed material.” Snyder (454) has

estimated that nearly half of all VDTs now in use

are improperly designed for intensive office use.

VDTs have usually been placed into workplaces

without consideration of the available lighting.

There has been a tendency to believe that more

light creates a better environment for office workers. The result is that many offices are overlit or

too bright for certain activities. This is a particular problem in offices with VDTs, Increasing the

light level, up to a point, improves contrast and

visibility for most office tasks. VDTs, however,

emit their own light and increasing illumination

Table 7-3.--Frequency of Reported Visual Problems From Various Studies

of VDT Workers

Percent reporting frequent problemsa

Burning,

itching, Blurring,

Study/type of worker Eyestrain irritation double vision

Holler, et al., 1975:

VDT user . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 N.A. 7

Arndt, 1980:

Telephone operatorb 

. . . . . . . . . . . . . . . . . . . . . . . 8 N.A. 1-5

Service assistant . . . . . . . . . . . . . . . . . . . . . . . . . 9 N.A. 1-4

Accounting clerkb . . . . . . . . . . . . . . . . . . . . . . . . . 6 N.A. 1-3

Laubli, et al., 1980:

Data-entry VDT operator. . . . . . . . . . . . . . . . . . . . 20 N.A. N.A.

Conversational VDT operator. . . . . . . . . . . . . . . . 28 N.A. N.A.

Typist. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 N.A. N.A.

Traditional office worker . . . . . . . . . . . . . . . . . . . 5 N.A. N.A.

Canadian Labour Congress, 1982:

VDT operator ... , . . . . . . . . . . . . . . . . . . . . . . . . . N.A. 9-17 13-16

Non-VDT operator . . . . . . . . . . . . . . . . . . . . . . . . . N.A. 7-8 8-9

Sauter, et al., 1982:

VDT newspaper editor . . . . . . . . . . . . . . . . . . . . . 40 43-46 N.A.

Non-VDT newspaper editor . . . . . . . . . . . . . . . . . 17 17-22 N.A.

Sauter, et al., 1983:

VDT operator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 19-27 5

Non-VDT operator . . . . . . . . . . . . . . . . . . . . . . . . . 20 21-23 5

aFreqUenCY of problems reported daily, constantly, often, vew often, freWJentlY.

bApproximately 33 percent used ‘fDTs.

N.A. = Not available.

SOURCE: (25).
Ch. 7—Ergonomics and Human Factors ● 139

levels actually reduces the contrast and visibility

of the screen image.

It is frequently suggested that the general lighting level in a room be somewhat reduced for

screen-based work. An alternative recommendation is to provide even lower levels, with supplementary task lighting for reading text from

paper and for other non-VDT work. Other illumiSUMMARY

Ergonomics —techniques for examining workermachine interactions and design of machines to

fit workers better—can be important in reducing

injuries and discomfort from repetitive motions

and other work activities. Information ergonomics

involves workers’ receipt of sensory information

and how it is processed; physical ergonomics deals

with worker body size, strength, and stresses

while working. Generally, when faced with a

problem in the workplace, ergonomists systematically analyze the job using biomechanical, physiological, psychophysical, and epidemiological

analyses; each job element is compared with factors known to be associated with overt or repetination problems that must be addressed concern

reflections off the VDT screen, glare, and contrast.

There are techniques for reducing and eliminating most of these problems and for enhancing the

ability of each worker to adjust the environment

of the VDT to fit his or her needs. Unfortunately,

these techniques have very often been ignored by

manufacturers, vendors, and employers (25).

tive trauma injuries. Changing work practices,

tools, and machine design and redesigning plant

layout are among the principal ergonomic solutions. There are many examples of the incidence

of carpal tunnel syndrome and back disorders,

two common repetitive trauma injuries among industrial and office workers, being reduced through

the use of ergonomic designs. In addition to preventing overt and cumulative trauma injuries,

ergonomic design has been shown to increase

worker productivity and efficiency by making the

machine or tool more closely fit the worker and

the worker’s capabilities.
8.

Personal Protective Equipment
8-1.

8-2.

8-3.

8-4.

8’-5.

8-6.

Comparison of Extrapolated and Measured Respirator Protection

Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . 148

Comparison of Noise Reduction Achieved by Insert-Type Hearing ,

● . . . . . . . .

Protectors in the Laboratory and in Field Use . . . . . . . . . . . . . . . . . . . . . . . . . 158

NIOSH Testing of Various Types of Personal Protection Equipment.. ,,.. 160

Comparison of Various Protective Garment Materials’ Capacity to

Resist Penetration by Chlorinated Ethanes and PCB . . . . . . . . . . . . . . . . . . . . 167

Selected Information From BLS Survey of Head Injuries . . . . . . . . . . . . . . . . 168

Selected Information From BLS Survey of Eye Injuries . . . . . . . . . . . . . . . . . . l69

LIST OF FIGURES

Figure No. Page

8-1. Respiratory Protection Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144

8-2. Effect of “Non-wearing” on the Effectiveness of Respiratory Protection . . . 151’

&3. Protective Eyewear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
8

Personal Protective Equipment

Based on an analysis of the literature about personal protective equipment, OTA concludes that

the effectiveness of many of these devices, especially under conditions of use in the workplace,

has not been demonstrated. Instead, many devices

have been tested only in laboratory situations that

do not duplicate and may not even approximate

workplace conditions. The overall impression is

that test results tend to exaggerate the effectiveness of personal protective devices. Additionally,

the few in-workplace evaluations reveal that continual maintenance and supervision, which are seldom provided, are necessary for acceptable performance.

This discussion is divided into three parts.

Greater emphasis is placed on respirators and

hearing protectors than on all other personal protective devices. Respirators and hearing protection devices are primarily intended to protect

workers’ health, while most other personal protective devices are important for safety. Furthermore, both respirators and hearing protectors are

frequently mentioned in arguments about the costs

of workplace health. They have been and conRESPIRATORS

Dust masks, gas masks, and devices that supply

clean air to workers through hoses or from tanks

are all called respirators. The most common are

“dust masks” that employ fiber filters to prevent

particles from being inhaled (see fig. 8-l). The second general class of respirators are “gas masks, ”

familiar to most veterans of the armed forces.

They purify air contaminated with fumes and vapors by passing it through a chemical “sorbent. ”

Less common are air-supply devices. Figure 8-1

illustrates a variety of respirators. The disposable

face mask “dust mask” and the “reusable airpurifying respirator” are negative-pressure respirators and rely on the wearer’s breathing to pull

“outside” air across the filter or sorbent. The other

Photo credit E.I. du Pont de Nemours & Co.

Signs are frequently used to indicate when the use of

protective equipment is mandatory

tinue to be suggested as less expensive and equally

effective alternatives to engineering controls for

health risks. Knowledge of the effectiveness of

these devices is thus important for making comparisons of the costs and benefits of personal protective equipment versus engineering controls.

respirators shown in the figure, all air-supply devices, are positive-pressure respirators, which

supply clean air to the wearer from a tank, from

a hose that originates in an area of clean air, or

from a hose that supplies air that has been purified

by passage through a filter or sorbent.

Federal involvement in testing and certifying

respirators originated in congressional and public concern about coal mine safety. Beginning in

the Civil War period, a number of bills were introduced and passed by one or the other House

of Congress to set up an agency with responsibility over mineral industries. In 1910, a series of

dramatic mine disasters led Congress to establish

143
144 ● Preventing Illness and Injury in the Workplace

Abrasive bias.tlng helmet

by 3M

Figure 8-1 .- Respiratory Protection Devices

Powered alr purtfying helmet

by Racal

Disposable respirator

by 3M

Reusable air-purifying

respirator by Cesco

Airline respirator

by Willson

Self-contained breathing

apparatus by Globe
Ch. 8—Persona/ Protective Equipment 145

Photo credit Department of Labor, Historical Office

An example of a respirator from earlier in this century

the Bureau of Mines in the Department of the Interior. The Bureau was interested in techniques

and equipment for use in mine rescue operations,

and, because the air in mines following cave-ins

and fires was often unfit to breathe, some effort

was devoted to development of respiratory protection.

The use of poison gases during World War I

spurred on the work of the Bureau of Mines,

which cooperated with the military to develop

masks for use by American soldiers in France. In

1919, following the war, the Bureau published

procedures by which manufacturers could apply

for certification of gas masks and breathing apparatus for use in mine rescues (438).

In 1969, Congress brought the Department of

Health, Education, and Welfare into respiratory

protection certification. The Federal Coal Mine

Health and Safety Act of that year included the

Department’s Bureau of Occupational Safety and

Health in a joint certification and testing program

with the Bureau of Mines. A year later, the Bureau of Occupational Safety and Health was replaced by the newly created National Institute for

Occupational Safety and Health (NIOSH), and

responsibility for testing and certifying respirators

was assigned jointly to NIOSH and the Bureau

of Mines by the Occupational Safety and Health

(OSH) Act. (The mine safety function was moved

to the Department of Labor in 1977 and is now

called the Mine Safety and Health Administration

(MSHA).) More importantly, Federal regulations

require that industrial users select federally approved respirators, if they are available.

Under authority of the Federal Mine Safety and

Health Act of 1977, NIOSH established a laboratory to certify respiratory protective devices, Although the Occupational Safety and Health Administration (OSHA) can accept testing results for

certification from any laboratory, it has chosen

to accept only NIOSH certifications. Therefore,

there is one laboratory responsible for respiratory

protection certification (68).

Qualitative and Quantitative

Fit Testing of Respirators

Most tests of respirator effectiveness are conducted in laboratories and usually maximize the

apparent effectiveness of the devices. For instance,

most air-purifying (negative-pressure) respirators

depend on the user’s inhalation to create a negative pressure inside the mask. In theory, the only

source of air to equalize the pressure is air that

passes through the air-purifying system (i.e., a filter or sorbent). The practical realization of the

theory requires that the seal between the edges

of the mask and the wearer’s face be sufficiently

tight to prevent contaminated air leaking in from

the sides.

Many factors may reduce the security of the

seal-changes in the tension of the headstraps that
146 . Preventing Illness and Injury in the Workplace

secure the mask, daily growth of facial hair or

the presence or absence of a beard, perspiration,

head movements, and talking. Although laboratory tests attempt to make allowances for such

factors, no test duplicates “field situations.” Two

general methods are available to test whether the

respirator is properly worn, and, indeed, if a particular respirator can protect an individual.

The “qualitative fit test” relies on the sensory

perception of the worker wearing the mask. A

chemical that has a distinctive smell or taste (isoamyl acetate, which smells like bananas, or saccharin) or that is an irritant (stannic chloride or

titanium tetrachloride) is introduced into a chamber where someone is wearing a respirator. If the

wearer detects the smell or irritation, the fit of

the mask is judged to be inadequate. In a program

designed to match appropriate respirators to people with different facial shapes, other masks would

be tried until one was found that passed the qualitative fit test.

The “quantitative fit test,” on the other hand,

uses instruments to measure concentrations of the

contaminant inside and outside the mask. For

instance, the respirator-wearing worker can be

subjected to an atmosphere containing dioctyl

phthalate (DOP), and instruments can be used to

measure concentrations of DOP. This method has

two obvious advantages: It does not depend on

human sensory perceptions, which may vary between workers and for a single worker depending on a number of factors, and it provides a

quantitative measure of how well the respirator

works.

The quantitative measure is generally expressed

as a “protection factor” or “PF,” the ratio of the

concentration of the test substance outside and

inside the mask. One disadvantage is cost. The

testing requires highly trained personnel and the

necessary equipment costs up to $10,000, according to a 1978 NIOSH estimate. Another disadvantage is that DOP, as is the case with many phthalates, is a suspect carcinogen. Substitution of

another test agent is possible, and aerosols of

sodium chloride (table salt) have been used in

some tests.

Wilmes (673,674) provides a readable and informative discussion of the two types of fit tests.

He maintains that quantitative measurements, although providing greater precision, are not worth

the additional costs. Instead, the money saved

from not doing the quantitative tests would be

better spent by increasing efforts directed at instruction of workers and reinforcement of good

respirator habits, careful maintenance, and education of workers, supervisors, and managers

about the importance of respirators. Additionally,

he states that provision of different models of

respirators, which costs money, is a better investment because it allows workers to choose respirators on the basis of comfort. A respirator that is

not worn provides no protection; having a single

model of respirator that, in tests, provides excellent protection but is uncomfortable does not

provide good workplace protection.

Wilmes’s position is not shared by others. Both

NIOSH and the Los Alamos Scientific Laboratory

(LASL) endorse quantitative fit procedures. In

their opinion, a worker’s sense of smell and taste

may be insensitive under certain conditions—

allowing mistakes to be made. Mistakes may be

especially common if the worker tries several

masks and his or her senses become jaded to the

test substance. A worker who is in a hurry may

say that the respirator is “okay” too quickly.

Alternatively, as demonstrated by a study discussed later in this chapter, the worker may

“smell” the test substance even though it is not

detectable by instruments. Finally, only a quantitative fit test provides information about the degree of protection.

Disagreements about the merits of quantitative

fit tests have been going on for years, with OSHA,

for instance, taking different positions at different

times. The lead standard that became final in 1978

required quantitative fit testing. However, revisions made in 1982 allow qualitative testing. If,

as is expected, NIOSH formally requires quantitative tests in its revised respirator testing regulations, the argument about certification tests will

be settled. Arguments will probably continue

about what methods employers should use to fit

respirators.
.—. — —.—

Ch. 8—Personal Protective Equipment ● 147

Use of Qualitative and Quantitative Fit Tests in

Certification Programs

Currently, under the provisions of 30 CFR Part

11, NIOSH certification of respirators employs

the isoamyl acetate (IAA) fit test. A panel of people chosen to represent a cross section of facial

sizes and shapes tests each mask. Each subject is

first checked to ensure that he or she can smell

IAA; in general, people chosen to participate in

the tests can detect it at concentrations of 1 to 3

parts per million. A subject enters a chamber in

which the concentration of isoamyl acetate is between 100 and 1,000 parts per million and is asked

whether the respirator prevented him or her from

smelling the chemical. The minimum requirement

is

six persons will each wear the apparatus in the

test concentration. . . for 2 minutes and none

shall detect the odor or taste of the test vapor (30

CFR 11.85-19).

Evidently, NIOSH is moving away from qualitative tests and toward requiring quantitative fit

tests. According to Wilmes (673), NIOSH objected

to the 1980 American National Standards Institute (ANSI) consensus standard on respirators that

included reliance on the qualitative fit test because

the agency concluded that such a test was unable

to predict fit. The ANSI Board of Standard Review considered NIOSH’s objection and decided

that it was without merit, a decision NIOSH appealed to the ANSI Board of Directors. But in

1980 the agency agreed to the consensus standard with the provision that a statement be added

to it saying that NIOSH takes the position that

only quantitative fit tests should be used.

Comparing Results of Qualitative and

Quantitative Fit Tests

A former Chairman of the ANSI Respiratory

Practices Standard Subcommittee has reported a

comparison of results obtained in the two types

of fit tests (386). Four models of NIOSH/MSHA

approved respirators were tested by 22 people (19

males and 3 females) using qualitative and quantitative methods.

Importantly, all respirator wearers who did not

smell IAA in the qualitative fit test were protected

to a PF of at least 10 (as measured by the quantitative fit test in the laboratory). Therefore,

according to these study results and assuming that

a PF of 10 is sufficient and that a test-measured

PF of 10 is reflective of the protection to be expected on the shop floor, an employer can qualitatively test various respirators and select one that

will provide adequate protection.

Unfortunately, 16 of the 22 workers, who—according to the quantitative fit test-were protected

to a PF of at least 10, reported smelling MA. This

suggests that an employer who relies upon qualitative fit tests might also have to provide other

respirators for workers who detect with a particular mask IAA even though a quantitative test

would show that they would be adequately protected. In other words, although the quantitative

fit test costs more, for instruments and operators,

its absence may also generate costs because workers’ senses lead them to report a poorer fit than

has been achieved.

The Los Alamos Scientific Laboratory

Tests of Respirators

The Los Alamos Scientific Laboratory studies

are the major work on respirator effectiveness,

Begun in 1969, they are gererally regarded as

thorough and definitive studies. Nevertheless,

their importance does not appear to be based on

their superiority to other studies. Rather, they appear to be the only studies available for many respirator types.

LASL used the DOP quantitative tests to measure and assign PFs to classes, or categories, of

respirators. The standard for assigning a PF to a

class was to determine the highest PF obtained by

95 percent of all subjects using each respirator in

the category. In practice, that means the “class”

PF was determined by the poorest performing respirator in the class. For instance, the testing of

“full-facepiece air-purifying respirators” involved

six different masks. The one that provided the

lowest protection was shown to protect 97 percent of the tested men to a PF of SO, so that category was assigned a PF of sO. Other masks in the

same class provided better protection; the best

provided a PF of at least 2,000 for 97 percent of

tested men.
148 . Preventing Illness and Injury in the Workplace

At the end of the first phase of testing, LASL

assigned PFs to the classes of respirators it tested

and extrapolated PF values for other classes (219).

As expected, positive-pressure masks provided

higher PFs, from 1,000 to 10,000. Positive pressure tends to blow contaminants away from any

leaks or ventings around the mask, minimizing

the influence of differences in personal anatomy.

By contrast, negative-pressure respirators tend

to suck contaminants into the protective mask

through any openings, which makes proper fitting critical. The highest PF assigned to any class

of negative-pressure respirator was 50, although

some specific respirators in some classes achieved

much higher PFs. The PF assigned to a class was

judged to be applicable for all respirators of that

class that are used in a respirator program that

includes routine equipment maintenance and qualitative fit testing.

In a subsequent phase of testing, LASL measured PFs for other classes of respirators and compared them with the extrapolated PFs. In the examples of this work given in table 8-1, measured

PFs were found to be higher for positive-pressure

respirators than the earlier extrapolated values,

and the measured PFs for a class of negative-pressure masks was lower (196).

Also shown in table 8-1 is an exception to the

general trend of extrapolated values for positivepressure respirators underestimating their effectiveness. NIOSH (580), after a complaint,, earned

out field studies of one model of “high-efficiency

Powered Air-Purifying Respirator (PAPR)” and

found that measured PFs in the workplace were

significantly below the PF of 1,000 extrapolated

from LASL tests.

Before 1969, when the LASL studies began, no

one had conducted laboratory tests of respirators

in a systematic fashion. Furthermore, the first field

studies of respirator effectiveness were not published until 1973 (see section on field testing later

in this chapter) and few have been reported. Two

million workers who wear respirators rely on this

limited research for assurance of protection.

“Dust Masks"

The progenitor of the most widely used type

of respiratory protection was a defective bra cup

that fell off an assembly line in 1972. “Someone

with a bright idea at 3M Corporation clipped an

elastic band to the fiber cup and produced the first

disposable dust mask, which, with some modifications, now claims the largest share of the multiTable 8-1.—Comparison of Extrapolated and Measured Respirator Protection Factors

Extrapolated

Pressure protection

Class of respiratora

in mask factor Measured protection factor

Loose-fitting supplied air hood . . positive 2,000 b,c 2 tests <1,000

9 tests 1,000-10,000

36 tests >10,000

47 tests totald

Continuous-flow supplied air:

Half-mask ., . . . . . . . . . . . . . . . . positive 1,000 10,000 (combined results,

Full-facepiece ... , . . . . . . . . . . . positive 2,000 both half- and full-facepiece)e

Pressure demand:

Half-mask . . . . . . . . . . . . . . . . . . positive 1$300 20,000 (combined results,

Full-facepiece . . . . . . . . . . . . . . . positive 2,000 both half- and full-facepiece)e

Demand:

Half-mask . . . . . . . . . . . . . . . . . . negative 10 <5 (93 percent attained PF

Full-facepiece . . . . . . . . . . . . . . . negative 50 of 5)*

Powered air-purifying respirator

(PAPR) . . . . . . . . . . . . . . . . . . . . . positive 1,000 <15 percent achieved PF of

1,000f

~he respirators are descrlbad in Working Paper #9.

bprotectlon factor (pF) reached by at least 95 percent of subjects wearing any respirator of that class

cHyatt (219).

dbu~la~l Hesch, and LOWV (152)

‘Hack, et al. (196)

‘NIOSH (580)

SOURCE Office of Technology Assessment from cited references.
Ch. 8—Personal Protectlve Equipment ● 149

Photo credit: NIOSH

A worker wears a powered air-purifying respirator

(PAPR) during a NIOSH field study

million dollar market for industrial respirators. . .“

(178a).

Lowry, Hesch, and Revoir (272) tested six

masks on a panel of 5 males and 5 females. Quantitative measurements of the leakage of sodium

chloide aerosols into the masks showed that only

two of the six masks provided a PF of at least 5

for all 10 subjects. These findings suggest that the

LASL study (219), which had earlier assigned a

PF of 5, overestimated the effectiveness of dust

masks.

Interestingly, the dust masks failed to provide

a PF of 5 far more often for females than for

males. Gillen (181) pointed out that two models

that, as tested, provided a PF of at least 5 for men

would fail to provide that level of protection for

17 percent of women because of differences in face

size. Another model that, as tested, provided a

PF of at least 5 for 94 percent of men would fail

to provide that level of protection for 56 percent

of women. Given the large number of women employed in some dusty trades, such as the textile

industry, and the increased participation in the labor force by women, the poor level of protection

accorded women is especially noteworthy.

There is often little warning that a dust mask

has failed to provide protection. In very dusty

workplaces, the first indication may be streaks of

dust on the worker’s face. Short of such drastic

failures, tasting or feeling the dusty material on

the mouth or nose may alert the worker to the

absence of sufficient protection. On the other

hand, a person’s senses may become acclimated

to the dust, rendering the worker unable to detect

the mask’s failure.

Field Testing of Respirators

Duplicating a worker’s movements and activities in a laboratory is difficult. In the course of

a day, a worker walks or rides or runs from place

to place, reaches and lifts, bends and stretches,

gestures and converses, eats and drinks. Each of

those actions may affect the fit of a respirator,

and some of them require its removal. Even if the

respirator, at the start of the workday, provided

protection equivalent to that measured in the laboratory, it is unlikely that those conditions would

prevail at the end of a shift.

A few reports describe field testing of respirators. The more sophisticated tests involve attaching one sampling device to the worker’s clothing and one inside the respirator and measuring

concentrations of airborne dusts, fumes, and

vapors inside and outside the respirator. Other

evaluations depend on collecting “pencil and paper” data about whether government-approved

respirators are used in the workplace, whether the

mask is the appropriate type for the hazard,

whether respirators are worn correctly and at the

right times, and whether the equipment is properly maintained.

Protective Factors Realized in Field Studies

of Respirators

NIOSH (59) has reported on the use of respirators in the abrasive blasting industry during 1971-

73. The results were not encouraging. PFs (which

according to current NIOSH usage would be program protective factors; see box F) ranged from

less than 2 to 3,750. Lower PFs were associated

with poor maintenance, poor training, poor fit-
150 . Preventing Illness and Injury in the Workplace

ting of respirators, and inadequate supervision of

use. Although in many cases inappropriate respirators were used, low PFs (2 or less) were found

in at least some cases with all types of respirators,

pointing to problems of fit, maintenance, and use.

Similar findings of poor respiratory protection

were also reported in NIOSH-contracted studies

of paint-spraying operations (481) and coal mining (200,201,202). The coal mine study measured

the effective protection factor (EPF) and the

workplace protection factor (WPF).

The EPF was determined by measuring dust

concentrations inside and outside the respirator

during a complete workshift, whether the respirator was being used or was hanging from the wearer’s neck. Twenty tests (11 percent) produced EPFs

greater than 10; 54 (29 percent), less than 2.0; and

16(9 percent), less than 1.0. The EPFs of less than

1.0—which mean that the concentration inside the

mask was higher than the concentration outside—

are thought to have resulted from dust collecting

in respirators while hanging around miners’ necks.

One general conclusion reached from the study

was that miners did not wear their masks enough

(201).

The WPF was measured during a half-shift

timespan after the respirator was donned according to the manufacturer’s instruction. As expected,

WPFs tended to be higher because of the attention given to fitting the respirators. Two respirators produced mean average WPFs of greater than

11 on all nine of the miners who participated in

the study; all five tested respirators produced

WPFs greater than 5 on all nine men. Therefore,

the observed WPFs show that PFs approaching

those measured in the laboratory can be achieved,

at least for relatively short periods of time under

conditions of close observation and continuous

use. However, the EPFs show that those high

levels of protection were seldom reached under

conditions of normal use.

Smith, et al. (450) observed a wide range of

EPFs (from 1.12 to 146) in a study of cadmium

workers, which resulted partly from workers deciding whether or not to wear respirators in different situations.

The paucity of information on how effective

respirators are in the workplace is well illustrated

by the observation of these authors that “only one

other published study was found on the effective

protection provided by intermittent respirator

usage.”

The major—and, in retrospect, perhaps obvious—conclusions reached from the papers by

Hams, et al. (201) and Smith, et al. (450) are that

respirators do not afford protection unless they

are worn and that the degree to which they afford protection depends on how well they fit and

how well they are maintained.

Figure 8-2 illustrates the rapid decrease in EPF

as the time the respirator is not worn increases.

The uppermost curve shows that not wearing a

respirator with a WPF of 10 for 1 minute each

hour reduces the EPF to 90 percent of the WPF;
Ch. 8—Personal Protective Equipment 151

Figure 8-2.—Effect of “Non-wearing” on the Effectiveness of Respiratory

100 J

Protection

0 1 2 3 4 5

Minutes respirator is not worn per hour

SOURCE Adapted from (403)

for 6 minutes, it drops to less than 70 percent. The results of field testing. The LASL

EPFs, then, if a respirator with a WPF of 10 is assigned a PF of 10 to half-mask,

6

studies (219)

air-purifying

not worn for 1 minute or 6 minutes each hour

become 9 and less than 7 respectively. The percentage decrease increases with higher WPFs; a

respirator with a WPF of 100 that is not worn for

1 minute per hour provides an EPF of only about

40; if not worn for 6 minutes, the EPF is only

about 10 (403).

Before turning from the limited information

about effectiveness of respirators in the workplace, the protective factors assigned on the basis

of laboratory tests can be compared with the

respirators. In the coal miners’ study (201), an

overall median EPF of 3.2 was observed; in the

cadmium workers’ study (450), a geometric mean

of 3.9 was noted, “which compares favorably with

the median 3.2 found by Hams, et al.” Overall,

then, the protection factors realized by workers

in those two studies were about one-third those

predicted in the laboratory.

The mean and median (or average) effective

protective factors obscure the high and low EPFs

obtained by some workers. In the study of coal
152 ● Preventing Illness and Injury in the Workplace

miners, 11 percent of EPFs exceeded 10; some were

as high as 20. In the cadmium workers’ study, 22

percent of EPFs exceeded 10. Furthermore, in the

latter study, one “fastidious worker,” who was

exposed to the highest levels of cadmium also

achieved the highest EPF. On the other hand,

about 9 percent of miners achieved EPFs of less

than 1.0 and 29 percent had less than 2.0 (450).

Miners who realized EPFs of less than 1.0 were

worse off than if they had not worn a mask at

all. Those achieving EPFs of less than 2.0 were

little better off although they might have thought

they were protected from airborne hazards.

Dixon and Nelson (145) and Myers (315) reported EPFs that stand in marked contrast to those

reported above. The first authors found WPFs

ranging from 40 to greater than 27,000 for workers who had been instructed in the proper use of

respirators and who wore masks during the 30

minutes to 2 hours necessary to complete specific

tasks. One reason offered for the greater efficiency

was the use of a new model of respirator (146).

Use of silicon rubber for the facepiece produces

a much more comfortable fit with the face, and

the mask can be worn for longer periods without

causing discomfort that leads to easing the respirator off the face.

By another measure, Dixon and Nelson (145,

146) determined the Program Protection Factor

(PPF) for a respirator program directed against

lead. In six of seven groups of workers who wore

respirators, the PPF was about 36. Technical

problems prevented accurate measurement of the

PPF in the seventh group, but those workers also

achieved significant protection.

Myers (315) measured WPFs in a primary lead

smelter and a blast furnace area. The median

WPFs were 450 and 130, respectively, with ranges

from 110 to 2,200 and from 10 to greater than

1,700. (The respirators that were used in those

workplaces had rated protective factors of 10

based on the LASL studies.)

Dixon and Nelson (146) state that higher WPFs

were seen in their own work and in Myers’ studies

because the research was carried out in workplaces with good respirator programs and “adequate fit testing.”

Several reports of studies of respirator effectiveness in the workplace are soon to appear or have

just been published (674a). The founding in 1982

of a new professional society, the International

Society for Respiratory Protection, and its publication of an international journal are expected

to increase the availability of information about

testing.

Deficiencies in Respirator Programs

Nicas (329) prepared a working paper about

respiratory protection programs for the use of

unions affected by the cotton dust and lead standards. The paper drew attention to deficiencies in

many respirator programs because of poor maintenance and supervision, to the limited testing of

respirators in the workplace, and to the costs of

maintaining an effective respirator program.

The sometimes high cost of a proper respiratory protection program (111) was suggested as

a bargaining chip in labor-management negotiations about whether to install engineering controls

or depend on respirator programs. The paper by

Nicas (329) is especially interesting because it provides a concise, readable review of the respirator

testing literature. As it is available only in a

photocopied form, it has a limited distribution,

however.

Dixon and Nelson (146) point out the importance of good respirator programs in achieving

high protection factors. Rosenthal and Paull (402)

examined OSHA inspection records to determine

how frequently respirator programs were cited for

falling below OSHA standards. From 1977 through

1982, at least one respirator program violation

was found in about 10 percent of all OSHA health

inspections. “All” health inspections includes those

of establishments that have no respirator programs. They (402) estimate that 27 percent of all

respirator programs were in violation of all

OSHA respirator program standard. This percentage was constant over the 6 years from 1977 to

1982. The importance of respirator programs is

underlined by their finding that respirator program deficiencies were found in 40 to 70 percent

of inspections in which overexposure was documented.
— -.

Ch. 8—Personal Protective Equipment 153

Adequate respirator programs include providing, maintaining, and insisting on the proper

wearing of respirators. Given that more than a

quarter of all OSHA-inspected respirator programs are cited for noncompliance, simply providing good respirators in a workplace is not

enough. Occupational health professionals insist

that careful attention to the respirator program

is essential, and they also point out that the costs

of such a complete program must be figured into

any comparison made between engineering controls and respirators (111).

NIOSH Certification of Respirators

NIOSH tests complete respirator systems consisting of the mask and any air-purifying filters,

cartridges, and canisters or air-supply apparatus.

The agency certifies the respirator for specified

uses (for instance, against a particular chemical)

and if the manufacturer subsequently decides that

certification of the same respirator against another

hazard is needed, the new use must be submitted

for NIOSH approval.

As part of this program, NIOSH purchases respirators from suppliers and checks that they meet

certification standards. Additionally, a program

that was initiated to investigate complaints about

inadequate respirator performance has been expanded to include field studies. The latter program

has been under way since 1981, and reports from

it are now appearing (315 and see below).

In large part, NIOSH’s testing specifications (30

CFR Part 11) were developed, published, and revised by the Bureau of Mines from 1920 through

1970. Those somewhat dated specifications adopted

by NIOSH in the early 1970s have been criticized

by industry (305,393) and Government officials

(360,572) because they are believed to restrict innovation in respirator design and to be inappropriate for testing devices that will be used in the

workplace (360, 610). To date, however, opponents of the current regulation have been unsuccessful in getting a new version adopted.

Increasing emphasis on workplace health has

been accompanied by a greatly increased work

load; in 53 years, the Bureau of Mines approved

340 devices, or about 6 each year. In 1981, NIOSH

issued 99 new approvals (67). This large number

of approvals does not show that innovative respirators have been introduced, for each time an

“old” design is cleared for a new use, it receives

an additional approval.

In general, the resources of NIOSH are seen as

being woefully inadequate to carry out all the

desired activities in the area of respiratory protection research and development, testing, and

certification (305,393).

OTA staff heard many complaints about NIOSH’s

testing and certification program—primarily that

it was slow, bureaucratic, restricted innovation,

and depended on outdated criteria for an acceptable respirator. While all those complaints evidently have some basis in fact, NIOSH is far from

satisfied with all the companies in the respirator

industry. For instance, the first test that NIOSH

applies to a respirator when it arrives for testing,

“the shake test, ” reflects that quality control is not

always good. In that test, a NIOSH employee

takes the respirator out of the box in which it arrives, shakes it vigorously, and if some piece falls

off, the mask is sent back to the manufacturer.

Possible Changes in NIOSH

Certification Procedures

NIOSH is considering changes in its respirator

testing regulations that would shift responsibility

for testing from the NIOSH laboratory to the

manufacturers (344). This approach follows suggestions by a group of five consultants to NIOSH

(73) who concluded that routine testing consumed

too many resources and that the current procedures lacked a feedback loop to alert NIOSH to

failures in respirators that were already on the

market. Evidently, the revisions forwarded to Dr.

Donald Millar, the Director of NIOSH, in early

summer 1983 would allow self-certification, but

he was not satisfied that NIOSH retained enough

authority to assure itself of the validity of the

manufacturers’ tests. The revisions are being

redrafted.

These changes would significantly alter the

process of testing respirators. NIOSH would no

longer receive samples of respirators and evaluate

them in its own laboratory. Instead, manufacturers would test respirators against standards to

be developed by NIOSH, and, when they are
154 ● Preventing illness and Injury in the Workplace

satisfied that the devices meet the requirements,

they would be allowed to represent the respirator as up to NIOSH standards. NIOSH’s role

would be essentially twofold: It would write the

standards, and it would carry out “spot checks”

of respirators on the market.

To play a more active role in self-certification,

NIOSH may, as part of the revised 30 CFR Part

11, reserve the right to see any data produced by

manufacturers in the self-certification process. In

addition, it could require notification by manufacturers of any major modifications in their

products.

The reported information (344) did not mention

a feedback loop for manufacturers or users to alert

NIOSH about failures in respirators. Such a process would seem to be necessary to ensure that

NIOSH could alert users to possible difficulties.

Union representatives, while generally supporting changes in the regulations about testing and

certification that would make the tests more predictive of workplace performance, favor NIOSH

continuing its testing and certification. One area

they single out for attention in any revision is

changes in the recertification process, by which

respirators are removed from commerce and use

when NIOSH finds they are deficient (610).

There are many rather vague suggestions that

the testing requirements of 30 CFR Part 11 be

changed to encourage innovations in respirator

design. John Moran, then chairman of the respirator Research Subcommittee and now director

of Safety Research at NIOSH, made a specific suggestion (310): that a minimum standard be set for

approval of all respirators of each class, as is now

done, and that higher standards also be indicated.

In this way, a manufacturer who produced a respirator that was significantly better than others

on the market would be rewarded with a higher

degree of certification, which would be useful in

marketing.

HEARING PROTECTORS

Exposure to continuous noise at levels greater

than 80 decibels (dB), about the noise level of a

garbage disposal at 3 feet or of a diesel truck travThird= Party Testing of Respirators

An alternative both to NIOSH testing and certification and to self-certification would be to have

the testing done by a third party, such as the

Safety Equipment Institute (SEI), which springs

from the Industrial Safety Equipment Association

(334). SEI would undertake certification only if

NIOSH leaves the field of routine respirator

testing, for there is no future in being a competitor with Government testing and certification. (A

description of SEI testing of other personal protective equipment is provided at the end of this

chapter. )

SEI argues that a third-party laboratory would

free the Government from routine testing and provide public assurance of higher quality testing

than is possible under self-certification. If arrangements were made for a third-party certification program, SEI estimates that it could establish a program within a year by contracting with

existing laboratories (672). Other estimates are

that 2 to 3 years would be needed to equip and

staff an adequate testing laboratory (610).

The idea of a third-party testing and certification program is supported by some manufacturers

but not others. Those who support it see an opportunity to have a more timely and responsive

program than NIOSH has been able to provide

and, at the same time, to increase acceptance over

what would be expected from self-certification.

Supporters draw an analogy between the suggested function and the Underwriters Laboratory

that certifies many electrical devices. Those who

oppose third-party certification see it as essentially

a self-certification program because safety equipment manufacturers are involved in SEI’s direction; although these critics do not fault self-certification, they are uneasy about a third-party

testing program that they see as under control of

the manufacturers.

cling at 40 miles per hour so feet away, may be

associated with progressive loss of hearing. Noise

above 90 dB is definitely associated with hearing
Ch. 8—Personal Protective Equipment ● 155

loss. Reduced noise exposures can be accomplished by engineering controls (redesigning, muffling, or enclosing machinery or providing workers with soundproof areas), by administrative

controls (reducing the time workers spend in noisy

areas), and by use of hearing protectors that reduce the level of noise reaching the workers’ ears.

OSHA requires employers to reduce workpace

noise levels to 90 dB (about the noise level encountered in a newspaper press room) by the use

of engineering or administrative controls. When

such controls are infeasible or cannot achieve 90

dB, employers must issue and require the use of

hearing protectors to reduce the noise exposure

to less than 90 dB (29 CFR 1910.95). In addition,

any worker who has lost a certain amount of

hearing ability, as defined by OSHA, must wear

hearing protectors if exposed to noise greater than

85 dB. The hearing protectors must work well

enough to reduce the noise that reaches the workers’ ears either to no more than 90 dB or, if some

hearing loss has already occurred, to no more than

85 dB.

Hearing Conservation Programs

Programs designed to reduce hearing loss generally have three components: identification of

noisy areas; implementation of engineering, administrative, and personal protection controls to

reduce exposure to noise; and audiometric testing

of workers to check that the controls are protecting hearing. Hearing protectors are an essential

part of hearing-conservation programs.

Economic considerations make it unlikely that

noise can be reduced at the source to acceptable

levels in the immediate future and isolation of

workers in sound-attenuating enclosures or reduction of an individual’s exposure time is not always

practical (389).

The Du Pont Company has maintained a program to protect workers’ hearing since the 1940s

(364). A study was undertaken of the hearing acuity among workers in three different situations:

quiet, office-like areas; work areas with noise

levels in the general range of 85 to 94 dBs; and

the noisiest work areas. Each of the men in the

study worked in one of the three noise levels for

5 years. The ability of each to hear noise at

various frequencies was established at the beginning of the 5-year exposure period and tested

again at the end.

Evidently the hearing conservation program

was quite successful over a period of at least 5

years. Changes in the hearing levels of workers

in the three noise levels were essentially the same

and did not vary depending on the hearing level

observed in the first measurement. The latter point

is important because there is the possibility that

workers who are already hearing-impaired might

be more sensitive to continued noise. Results from

the Du Pont study (364) showed that hearing-impaired workers, as well as workers with normal

hearing, were protected from further loss of hearing by a program that used hearing protectors in

noisy areas.

Despite those results, some reservations must

be attached to the conclusions drawn from the

study. Hearing loss is known to increase with time

of exposure, and studies conducted over periods

longer than 5 years are necessary to be certain of

the continued success of hearing conservation programs. The importance of longer-term studies is

apparent when it is remembered that many people work 40 to 45 years, and their hearing should

be conserved throughout that time.

Temporary Threshold Shift

Immediately following exposure to a sufficiently loud noise, the ability of a person to hear

quiet noises is reduced. Over time, unless there

has been permanent hearing impairment, the ability to hear quiet noises will return. Temporary

loss of hearing acuity is called temporary [hearing] threshold shift (TTS).

In hearing conservation programs, hearing tests

are administered 14 hours after the last exposure

to loud noise so that TTS will not interfere in the

person’s ability to hear. Richman (387), however,

argues that hearing loss involves a lengthening of

the period of TTS. He suggests that audiometric

testing within 4 or 6 hours after exposure would

pick up cases of TTS, and altered TTS readings

would alert the responsible authorities that hearing protection was insufficient. (Of course, in order to have a baseline for comparison, the initial

hearing tests should be made 14 or more hours

after the last noise exposure. )
156 . Preventing Illness and Injury in the Workplace

By changing the time of routine audiometric

testing to within 4 to 6 hours after exposure,

Richman (387) believes the tests would be more

useful for prevention of hearing loss. Testing only

at 14 hours after exposure, he feels, leaves the tests

unable to predict permanent hearing loss before

it can be prevented.

Methods of Audiometric Testing

Riko and Alberti (389) briefly describe the three

classes of audiometric testing, which differ in the

amount of reliance they place on the human sense

of hearing as opposed to the ability of instruments

to detect noise.

Real-Ear Attenuation at Threshold.—This

method depends on a person’s report of being able

to hear sounds. It resembles the classic “hearing

test” of a nurse or doctor whispering across the

room and asking the patient if the whisper can

be heard. In the workplace and in clinics, the realear attenuation at threshold (REAL) test involves

placing someone in an acoustically quiet room and

using earphones to generate defined levels of noise

at various frequencies. The worker then puts on

hearing protection, and the machine generates

noises at the same frequencies. The difference in

the intensity of noise that is heard with and without the protectors is a measure of the protection

afforded.

The REAL test is used more commonly than the

other two tests (“semiobjective” and “objective”)

described here. The audiometric tests used in hearing conservation programs are similar; the lowest

intensity of sound that a worker can hear is determined and recorded at the time of first employment. Subsequently—at the time of an annual

physical examination, perhaps—another REAL

test is administered.

Semiobjective. —This method eliminates the

complete dependence of the REAL method on a

person’s hearing, which is, to some extent, subjective. In the semiobjective test, a tiny microphone is positioned in the ear and the noise energy

is measured with and without a protector in place.

The major drawback of this test is that it is virtually impossible to evaluate any protectors that

are inserted into the ears.

Objective. —This method also uses microphones to detect noise levels, but it uses “an artificial head or ear” instead of a human subject. Although it is attractive to manufacture of hearing

protection devices because it would be convenient

for quality control, it has proved to be very difficult to simulate a human head.

Acceptance of Hearing Protectors

OSHA’s noise standard and its Hearing Conservation Amendment (625, 640) require employers

to provide hearing protection to their employees

and ensure that the protectors are worn. Compliance with requirements to wear hearing protectors is undermined by dissatisfaction with the devices. Workers often object to wearing earmuffs

in hot, humid conditions, and earplugs are so uncomfortable that some workers reject them. Additionally, earplugs can contribute to infections

in dusty, dirty environments, and earmuffs cannot be worn with glasses.

Furthermore, although some hearing protectors

are more comfortable than others, they all work

by creating a physical barrier to the passage of

sound, The seal between the protector and the

worker’s head or ear is of great importance to the

effectiveness of the protector. In general the seal

is created by pressure. The pressure creates discomfort and, for some workers, pain.

An interesting study (686) demonstrated that

quick feedback about the value of hearing protectors promoted their use. Hearing tests were

administered to some members of a metal fabrication department at the beginning and end of their

workshifts on 2 days over a l-month period. Exposure to workplace noise reduced aural acuity

sufficiently that pre- and post-work hearing tests

differed when hearing protection was not worn.

The people providing the tests discussed the implications of the results with workers, who congregated around the results that were posted in

the department, until everyone understood the

meaning of the test results.

According to the authors, workers’ appreciation of the value of the protectors resulted in a

change in accepted behavior; 5 months after the
Ch. 8—Personal Protective Equipment ● 157

program began, 85 to 90 percent of the workers

in the department wore their hearing protectors.

In contrast, only 10 percent of workers in another,

equally noisy, department who received a “standard lecture” about hearing conservation protection wore hearing protection. A subsequent attempt to discipline workers in that department

who did not wear hearing protectors failed because of both union and management resistance.

Union members objected because the disciplinary

action (removing workers from the noisy department) reduced the workers’ earnings, while management did not like losing the services of experienced workers.

Noise Reduction Ratings

As a result of the Noise Control Act of 1972,

the Environmental Protection Agency (EPA) beginning in 1979 required that all hearing protectors be labeled with a noise reduction rating

(NRR). The NRR is a single number that describes

the attenuation of noise that can be expected from

wearing the protectors. NRRs are used in connection with measured noise levels in the workplace

(640) to select appropriate hearing protectors.

As discussed in the beginning of this chapter,

all models of each class of respirator receive the

same protection factor, and only extrapolated PFs

are available for some classes of respirators

(219,580). In contrast, EPA required that each

model of hearing protector be labeled with its own

NRR.

Problems With Noise Reduction Ratings

The importance of accurately determining NRRs

was recognized by EPA, and that agency conducted a study to determine if NRRs were in

agreement by having four models of hearing protectors tested in seven laboratories. The NRRs reported on the labels of the four models tested had

all been determined in a single laboratory, which

was referred to as laboratory 8 in the study. Although EPA was unable to analyze the results because of budget cutbacks, three employees of two

private-sector companies did analyze the study (50).

The various laboratories differed quite consistently in measuring NRRs. That is, each laboratory tended to report low, medium, or high NRRs,

in comparison with the others, regardless of which

device was being tested, The authors felt “this fact

suggests the likelihood of a systematic bias in the

testing procedure. ” The paper explores the influence of proper or improper fitting of the hearing

protector, subject selection and training, and data

reduction techniques in producing the variability

among the laboratory measurements.

Perhaps the most striking finding was that

The labeled NRRs for all four devices were

based upon data from Laboratory 8, and even

though in some cases they were derated by the

manufacturers, all devices would have failed an

EPA compliance audit test conducted at any one

of the other seven facilities. This would have required relabeling. Since there now will be no enforcement of the labeling regulation [because of

EPA budget cutbacks], it is likely that manufacturer’s data will continue to reflect the highest

measurable values found today.

OSHA Use of Noise Reduction Ratings

One of the authors of the paper that compared

NRRs measured in different laboratories presented

similar evidence to OSHA during a hearing on

the Hearing Conservation Amendment (48). In

addition, he said that the laboratory that reported

the highest NRRs was responsible for “85 percent

of manufacturers’ reported NRRs. ” He also expressed the opinion of his company (E.A.R. Division of the Cabot Corp. ) that the NRRs should

be “de-rated” for two reasons: the generally high

NRRs determined by laboratory 8, and the substantial difference between results of laboratory

and field testing of hearing protectors.

OSHA mentions this testimony in its latest preamble to the Hearing Conservation Amendment

(640), and says that it will consider it in any

modification of the noise standard. In a 1983

directive, OSHA has instructed its inspectors not

to cite exposures between 90 and 100 dB as violations of the hearing conservation standard provided that the employees are wearing adequate

hearing protection. “Adequate” was described as

the NRR de-rated by 50 percent.

The situation regarding noise reduction ratings

needs correction, but there appears to be little

chance of that happening. A published report has
158 . Preventing Illness and Injury in the Workplace

presented evidence that the NRRs that appear on

package labels are higher than the NRRs determined in seven of the eight laboratories equipped

to carry out the appropriate tests (so). A company that manufactures hearing protectors has

written OSHA that the effectiveness of its product is overstated and that the protection offered

by the protectors in the field is lower than that

obtained in the laboratory. The Agency (EPA) responsible for ensuring that NRRs are assigned to

hearing protectors and that they are accurate has

discontinued its NRR program because of budget cutbacks and evidently will not change existing

NRRs. OSHA has instructed inspectors that the

NRRs are in error, but OSHA’s instructions to

employers about selecting appropriate hearing

protection (640) continue to rely on NRRs that

are almost certainly too high.

Field Testing of Hearing Protectors

Poor agreement between laboratory and field

tests was demonstrated by a NIOSH test of 420

workers at 15 industrial plants (267). Fifty percent of the workers achieved considerably less

than half the potential protection demonstrated

in the laboratory (table 8-2). Also shown in the

table is the level of protection achieved by the 10

percent of workers who received the least protection. At least 10 percent of the users of preformed

types of hearing protectors received no protection;

at least 10 percent of the users of the other types

of “earplug” hearing protectors received only 3

dB protection.

These results are consistent with the findings

of Riko and Alberti (389), who measured the attenuation of noise achieved by 400 workers using

their own protective devices. Although they do

not present numerical results, they state

. . . for both muffs and plugs, the average attenuation was less than that expected from manufacturer specifications and was considerably less

than their theoretical potential. Mean attenuation

was not as revealing, however, as the scatter of

attenuation scores, which was wide. For given frequencies, values ranging from O to 50 dB between

individuals were obtained. The use of standard

deviation measurement was avoided deliberately

because the distribution of attenuation was not

sufficiently uniform and was skewed in the direction of poorer attenuation values.

Riko and Alberti’s comments about the scatter

of attenuation are often repeated in discussing

hearing protection. Although some workers obtain satisfactory protection, others obtain none

or hardly any. In some cases, the hearing protection simply doesn’t fit or doesn’t work. The solution generally suggested for that problem is to offer the worker a variety of protectors so that

comfortable ones can be selected; the worker’s

selection should be checked by an audiometric test

to be certain that it provides hearing protection.

Another solution is to reduce noise exposures

through engineering controls.

Table 8-2.—Comparison of Noise Reduction Achieved by Insert-Type

Hearing Protector In the Laboratory and in Field Use

Median noise reduction ratingsa

Protection obtained by

Type of protector laboratory field lowest 10°/0 in fieldb

All earplugs. . . . . . . . . . . 28 13 —

Preformed types. . . . . . . 29 7 0

Acoustic Wool . . . . . . . . 26 10 3

Custom-molded c . . . . . . 20 3

Acoustic foam . . . . . . . . 36 : 3

%Aeaeurementa in dB.

bAvarage noise reduction mhlevm by tha 1(I percent of workera who obtained tha pooreet nOISe ProtOCtlon.

cln one plent, the Custorn.rnolded earpiuga wera fabricated by the plant nurse; In the other PlOnt, thay were fabricated by the

manufacturer.

SOURCE: (267).
Ch. 8—Persona/ Protective Equipment . 159

OTHER TYPES OF PERSONAL PROTECTIVE EQUIPMENT

NIOSH tests and certifies respirators, but no

other personal protective equipment. Formerly,

NIOSH also tested and certified several types of

measuring equipment, such as gas detector tubes,

coal-mine-dust personal sampler units, and industrial sound-level meters, but these programs were

discontinued in 1983.

According to NIOSH, some equipment is advertised as meeting “Federal” or “OSHA” standards. In fact, there are no general Federal or

OSHA standards for personal protective equipment. In some regulations OSHA requires that

safety equipment be worn and stipulates that the

equipment meet certain requirements, generally

ANSI standards. NIOSH concluded that the “Federal” or “OSHA” standard statements arise from

those requirements.

Personal protective equipment other than respirators is “self-certified” by the manufacturers,

who may test it to determine if it meets ANSI

standards. Equipment that conforms to the standard can be so advertised. Since few purchasers

have the facilities, professional staff, and other

resources to test safety equipment, knowing that

a device meets ANSI standards should provide

assurance to the purchaser and user that the equipment will provide a specified level of protection.

NIOSH Tests

In the mid-1970s NIOSH purchased samples of

personal protective equipment that was advertised

and sold as meeting ANSI standards. NIOSH

tested the samples to determine if they did, in fact,

meet the appropriate standard.

In several cases NIOSH noted some ambiguity

in the ANSI standards. Because of the possibility

of various interpretations of some standards,

NIOSH called together representatives of manufacturers, labor unions, and Federal agencies to

discuss the test procedures to be used in evaluating

the particular classes of equipment. In all cases,

NIOSH tested equipment against the ANSI standard, sometimes including modifications made after

the meeting; the agency did not draw up its own

requirements.

The principal finding from the NIOSH tests was

that many items of personal protective equipment

did not function as expected, given the ANSI

specifications (see table 8-3 for a summary of the

data in this section).

Head Protection

Hard Hats.—Protective headwear, all of which

is designed to protect against impacts, is classified

as A, B, or C depending on its resistance to transmitting electricity. Class A requires limited electrical protection, Class B requires higher electrical protection, and Class C requires no electrical

protection. (Reviewers of drafts of this report remarked on the classification that placed the most

protective units in the middle of an A-B-C classification scheme. )

NIOSH tested Class B industrial helmets “because they, as a class, offer the most comprehensive head protection available to the industrial

worker.” The tests revealed a distressingly high

failure rate. Only 4 of the 21 tested models passed

all the ANSI performance tests. Only 7 passed the

impact resistance test; 16, the electrical resistance

test. Hats that failed the impact test were found

to transmit too much force, and those that failed

the electrical test did not insulate as well as

claimed.

Photo credit OSHA, Office of Information and Consumer Affairs

Many employees are now required to wear hardhats

during the workday
160 . Preventing illness and Injury in the Workplace

Table 8-3.--NIOSH Testing of Various Types of Personal Protection Equipment

Number (percent)

Equipment type (reference) Number of models tested meeting ANSI performance standards

Head protection:

Class B industrial helmets (“hard hats” with

highest electrical resistance) (Cook and

Groce (1 16))

Miners’ safety caps (Cook and Love (120))

Firefighters’ helmets (Cook (117))

Eye protection:

Glass piano safety spectacles (Campbell and

Collins (92))

Plastic piano safety spectacles (Collins and

Wolfe (113))

Flexible fitting safety goggles (Campbell and

Collins (92))

Eyecup goggles (Campbell, Collins, and

Wolfe (93))

Welding filter plates (Campbell (91))

Face protection:

Industrial face shieids (Campbell (90))

Hand protection:

Linemen’s rubber insulating gloves (Cook

and Fletcher (119))

21 (“randomly selected”)

16 (all available models)

8 (6 advertised as meeting

ANSI standard)

22 (1 model from

manufacturer)

17 (1 model from

manufacturer)

each

each

50 (all available

models)

clear-lens

24 (1 model from each

manufacturer)

94 (all available shade

models)

37 (“representative

sample”)

12 (randomly selected and

representative of 155

available models)

4 (19°/0) met all performance standards

7 (33%) passed impact resistance test

16 (76%) electrical resistance test

20 (95%) passed crown clearance test

all passed penetration resistance test

13 (81 ‘/0) met all performance standards

14 (88°/0) passed electrical resistance test

15 (94°/0) passed impact resistance test

for the 6 advertised as meeting ANSI

standard, 4 met aII performance

standards and passed penetration

resistance, electrical resistance, and

self-extinguishing tests

21 (95°/0) passed Impact resistance test

(only 1 of 24 samples fractured of the

model that failed)

21 (95°/0) passed frame impact test

18 (82°/0) passed flammability tests

(failures were by small margin, judged

not to be major)

all passed optical quality tests

all passed impact resistance test (16 of 17

passed test at 5 times impact energy

required by ANSI)

all passed frame and lens penetration

resistance tests

7 (41 ?/0) passed flammability tests

(failures judged to present little danger

in workplace)

all passed optical quality tests

all passed impact resistance tests

all passed penetration resistance tests

48 (96%) passed “design test” that

estimated risk from particles entering

inside goggles through ventilation

opening

32 (64°/0) passed flammability test

33 (66%) did not meet ANSI optical

standards

13 (54%) passed impact resistance test

16 (67°/0) passed frame impact test

all passed flammability test

all passed optical transmittance test

19 (20%) met all performance standards

more than 90% passed ultraviolet,

infrared, and impact tests (when

appropriate)

76 (80°/0) passed visible-light

transmittance tests

36 (97°/0) passed impact resistance test

36 (97°/0) passed penetration resistance

test

ail passed flammability test

11 (92%) passed electrical resistance test

(model that failed electrical test was

withdrawn from market by manufacturer)

10 (84%) passed tensile strength
Ch. 8—Personal Protective Equipment ● 161

Table 8-3.—NIOSH Testing of Various Types of Personal Protection Equipment—Continued

Equipment type (reference) Number of models tested

Foot protection

Men’s safety-toe footwear (Cook (118)) 76 (random samples of

types in general use (71),

plus styles not

represented in general

samples (5))

Number (percent)

meeting ANSI performance standards

ANSI analysis:a

49 (55°/0) passed impact resistance tests

60 (79°/0) passed compression tests

43 (37°/0) passed overall tests

Statistical analysis:

28 (37°/0) passed impact resistance tests

50 (60°/0) passed compression tests

36-50 (48°/0-600/0) passed overall tests

 confidence level that 9 out of 10 shoes would ANSI test (see text)

SOURCE Office of Technology Assessment from cited references

The impact resistance test is conducted for vertical impacts only. A member of the advisory

panel to this OTA assessment reports that NIOSH

also conducted nonvertical impact tests—with

disastrous results. Those results were not reported

by NIOSH.

Miners’ Helmets. —Miners are required to wear

helmets in underground mines and in surface

mines where falling objects may create hazards.

NIOSH characterized 15 of the 16 models of

miners’ helmets as industrial helmets to which a

lamp and a cord bracket for mounting it have

been added. Miners’ helmets, like “hard hats, ” can

be Class A, B, or C, depending upon their resistance to electricity.

The miners’ safety caps had better test results

than the Class B hard hats: 15 of 16 models passed

the impact resistance test; 14, the electrical resistance test. Manufacturers had drilled holes for use

in attaching lamps to the 2 models that failed the

electrical tests; electrical shorts across the holes

caused those models to fail. Overall, 13 models

met all the ANSI performance standards.

Oddly, of the five companies making both

miners’ helmets and Class B hard hats, four produced a miners’ helmet that passed the the impact

resistance test and at least one model of Class B

hard hat that failed it. By contrast, the producer

of the miners’ helmet that failed the impact resistance test made a Class B hard hat that passed.

Firefighters’ Helmets. -Firefighters’ helmets differ in shape from hard hats and miners’ helmets,

and they have a broad brim to carry water away

from the wearer’s face and neck. In addition to

Photo credit: E. /. du Pont de Nemours & Co.

These firefighters are using protective clothing,

firefighters’ helmets, and self-contained

breathing apparatus

providing protection against impacts and electricity, firefighters’ helmets must also be selfextinguishing. NIOSH used two different methods to measure the transmission of impact forces

in testing firefighters’ helmets. An analysis showed

that the method they favored produced more consistent results; using that test, four of the six

models advertised as meeting the ANSI standard

passed the impact resistance test. All six models

passed the tests for electrical resistance and

penetration resistance, and all were self-extinguishing. NIOSH concluded that the two helmets

advertised as meeting ANSI standards that failed

the impact resistance test suffered from poor

quality control in the manufacture of the suspension systems.

The agency suggested that the tests for these

devices would more accurately reflect firefighters’
162 ● Preventing Illness and Injury in the Workplace

needs if an impact resistance test at 300o Centigrade (572 0 Fahrenheit) were added to the ANSI

standards. The severity of such a test reflects the

conditions that firefighters and their equipment

face.

Comments on Head Protection.—The tests

showed significant performance variations from

ANSI standards. The highest failure rates were

found in Class B hard hats, which are used in the

greatest numbers and manufactured by the largest

number of firms. The miners’ helmets, as a class,

performed very well. The single failure in the impact resistance test was associated with quality

control during manufacture, and the electrical test

failures were related to holes being drilled in the

helmets.

Overall, the performance of protective headwear in tests completed in 1976 and 1977 does not

produce confidence that the devices work as

claimed. Furthermore, NIOSH drew attention to

the absence of tests of impact resistance for the

front, sides, and rear of helmets, highlighting what

appears to be a deficiency in the tests. In the report on miners’ helmets, NIOSH noted that the

present ANSI standards do not consider the effects of projections into the interior of some

helmet models, which would tend to concentrate

the force of any impact from the front, sides, or

rear. After recommending that models with protrusions be avoided, NIOSH suggests a crude test

to identify them:

With the helmet in place, a cautious series of

blows to the perimeter of the helmet is sufficient

to identify models with these protrusions.

The report on Class B helmets acknowledged

that “It should be recognized that many lives have

been saved through use of industrial helmets and

such devices are a valuable adjunct to the overall protection of workers. ” However, apparently

in recognition of the deficiencies found in those

helmets, the agency added, “NIOSH intends to

promulgate regulations in the immediate future

to establish the legal basis for a testing and certification program for industrial helmets. ” That

was 8 years ago.

Protective Eyewear

Protective eyewear (fig. 8-3) is the most commonly used personal equipment. In the workplace, this equipment provides protection against

particles, sparks, and chemicals that might hit the

eye and/or protection against harmful ultraviolet,

infrared, and too-intense visible light. ANSI

specifies that protective eyewear must not affect

visual acuity to the point where a worker’s performance is impaired and certainly not to the

point where the worker’s safety is affected by reduced field or clarity of vision.

An obvious concern in safety eyewear is that

the eyewear itself can present a hazard if it fails.

A particle splintering the lens of spectacles may

be the cause of an accident, but the injury may

stem from fragments of the lens entering the eye.

Since 1972, all spectacles sold in the United States

must have impact-resistant lenses, but the level

of impact resistance in “street-wear” spectacles is

far below that required of safety eyewear used in

the workplace. To facilitate making a distinction

between lenses intended for street wear and those

for industrial use, all the latter spectacles are

marked with the manufacturer’s name.

Piano Safety Spectacles.—Glass (or plastic)

piano safety spectacles (“piano” means flat, noncorrective lens) are the “safety glasses” with which

most people are familiar. They are intended to

be a barrier between the eye and foreign objects

and not to interfere with the wearer’s vision.

NIOSH tested 22 models of glass safety spectacles, one from each manufacturer. All but one

model passed the impact resistance test prescribed

by ANSI. Twenty-four samples of each model

were tested, and even in the model that failed only

one lens of the 24 fractured. All the models passed

the frame impact test, which requires the lens to

remain in the frame after impacts on the side or

top.

The spectacles were also tested for resistance

to higher energy impacts, although the results of

this test did not affect NIOSH’S decision on whether a lens passed or failed the basic impact test.
Ch. 8–Personal Protective Equipment ● 163

Figure 8.3.—Protective Eyewear

 Service
164 . preventing Illness and Injury in the Workplace

NIOSH found that many lenses provided impact

resistance in excess of the ANSI requirements. For

5 models, none of the tested samples fractured at

impacts 2.5 times greater than the ANSI standard, and 467 of the 528 sample lenses exposed to

that much impact survived.

All models passed the optical quality tests, and

NIOSH considered overall optical quality to be

above the ANSI requirements.

Sideshields, constructed of wire mesh or plastic,

that cover the opening between the outside edge

of the glasses and the wearer’s face are necessary

to prevent particles from reaching the eye from

the side. NIOSH found that four models with

plastic sideshields did not pass the ANSI flammability test, but they considered these failures

to be of minor importance because they were

barely outside the acceptable range.

The plastic piano safety spectacles tested also

met ANSI standards. All 17 models, one from

each manufacturer, passed the lens and frame impact tests. Sixteen of the 17 passed a lens impact

test at 2.5 times the energy level specified by

ANSI, and NIOSH reported that the manufacturer of the one other model planned to change

its lenses to the more energy-resistant plastic.

Overall, plastic lenses provided more impact resistance than glass ones.

The optical quality of plastic lenses was sufficient to pass the ANSI standard, but below that

of glass lenses. An important tradeoff in selection

of safety spectacles is that glass lenses are more

resistant to abrasion, and they are generally chosen for use in situations where abrasion is a

problem.

Ten models of plastic safety spectacles did not

pass the flammability test because of sideshields

burning at rates greater than allowed by ANSI.

As with the glass models, however, the bum rate

was so close to the ANSI limit that NIOSH did

not consider these failures to be serious.

One difference between the ANSI tests for glass

and plastic spectacles is that glass lenses are not

tested for resistance to penetration. All plastic

lenses passed the lens penetration test specified by

ANSI. NIOSH commented that they would expect many glass lenses to fail that test, and that

they are unaware of why it is not required of glass

lenses.

Flexible Fitting Safety Goggles.—All the

NIOSH-tested flexible fitting safety goggles passed

the impact and penetration tests. Two of the 50

models suffered from design defects that would

allow particles to enter the eye area from the side,

and, as was found with the safety spectacles, the

plastic used in some of the goggle frames burned

at a rate slightly greater than allowed by ANSI.

The excess burn rate was not considered to be a

problem in most workplace situations. The optical quality of the goggles was poorer than that

of spectacles.

Eyecup Goggles. —Eyecup goggles performed

poorly. Eleven of the 24 models tested failed the

impact test. All the models that failed used flat

lenses, and no models with curved lenses failed.

In addition, the frames of eight models failed (all

the failures occurred in models that had also failed

the lens impact test). NIOSH concluded that

“many models of eyecup goggles were found to

be seriously defective and are considered to represent a significant hazard to the user”; unfortunately, the defects in eyecup goggles “are not detectable by the user. ” Overall, although some

eyecup goggles offered good protection, NIOSH

pointed out that safety spectacles and flexible fitting goggles provided better impact protection.

Welding Filter Plates. —The primary purpose

of welding filter plates is to protect the welder’s

eyes from intense ultraviolet, visible, and infrared

radiation. Different shades of plates are available,

depending on the type of welding and the radiation encountered on the job. NIOSH tested a total

of 94 different shade-models; only 20 percent met

all ANSI performance standards.

Comments on Protective Eyewear. -Testing of

protective eyewear showed that spectacles and

flexible fitting goggles performed well. Eyecup

goggles did not, as a class, provide the level of

protection specified by ANSI. Few welding plates

met all ANSI standards.

It is impossible to tell from the results reported

by NIOSH whether the failures were due to de-
Ch. 8—Personal Protective Equipment . 165

sign defects or poor quality control. An exception to that generalization is the two models of

flexible fitting goggles with design defects that

allowed particles to strike the eye from the side.

Face Protection

NIOSH tested faceshields that were attached to

hard hats. All but 1 of 37 models (a “representative sample” of those available) passed both the

impact and penetration tests. The same model

failed both tests. NIOSH concluded that the other

shields performed in accordance with ANSI standards, but warned, as do several manufacturers,

that shields are not a substitute for eye protection. Particles can pass around or under the shield

and cause injury if eye protection is not worn in

conjunction with the face protection.

Linemen’s Rubber Gloves

Only three manufacturers make the 155 models

of rubber gloves worn by electrical linemen to

provide protection against electrical shock.

NIOSH tested 12 models considered to be representative of all those available. Eleven models

passed the ANSI specified electrical resistance test.

The model that failed was, according to ANSI,

withdrawn from the market by the manufacturer.

One of the two models that failed the tensile

strength test was advertised as meeting the ANSI

standard; the other was not. These two are the

only models not made from rubber and are intended for use in areas with very high voltages.

NIOSH apparently sees the use of plastic in place

of rubber in these gloves as acceptable because

they offer superior service qualities in the specific

uses for which they are sold.

Photo credit OSHA, Office of /n format/on and Consumer Affairs

Faceshields and safety glasses protect these workers

from flying particles

Men’s Safety-Toe Footwear

Safety-toe footwear (more generally called

“steel-toed shoes”) are subjected to two performance tests. The impact resistance test measures the

deformation of the toe of the shoe when it is subjected to a single hit with a falling object. The

compression test measures the deformation during the application of a steady squeezing force.

Safety-toe shoes are rated by the manufacturers

on the basis of the shoes being able to withstand

an impact of 30, 50, or 75 foot-pounds and an

average compressive force of 1,000, 1,750, o r

2,500 pounds. The shoes are rated as Class 30,

SO, and 75 respectively. NIOSH tested 76 different

models, a random sample of those available.

The ANSI standard is based on a pass/fail test.

NIOSH analyzed its results on this basis as well

as on another statistical basis. The statistical analysis considered how close each model came to failing the test, and resulted in an estimate of the 95

percent probability that at least 90 percent of all

shoes of that model would pass the test.

Using the ANSI standard, 49 of 76 models

passed the impact tests; 60, the compression tests;

only 43, both tests. The statistical test resulted in

28 of 76 models passing the impact tests; 50, the

compression tests; 36-50 the overall tests.
166 . Preventing Illness and Injury in the Workplace

Under both methods of analysis, a significant

proportion of the tested shoes did not conform

to the ANSI standard. NIOSH concluded that

manufacturers overrate the shoes. For instance,

a shoe marketed as Class 75 provided only the

protection required of a Class 50 shoe. NIOSH

also noted, however, that some cases of failure,

in which the shoe deformed just past the fail mark,

might not be associated with an injury in actual

use, and that safety shoes have afforded a substantial degree of protection to workers.

Comments on NIOSH Testing of

Personal Protective Equipment

Some types of safety equipment—notably spectacles, flexible goggles, miners’ helmets, linemen’s

rubber gloves, and face protection—were found

to conform to the ANSI standard against which

Photo credit: E.I. du Pont de Nemours & Co

Protective clothing is frequently required for exposures

to toxic substances

they were manufactured. Others—safety-toe

shoes, eyecup goggles, industrial safety helmets,

firefighters’ helmets, and welding filter plates—

often did not measure up to the ANSI standards.

Furthermore, some deficiencies were found in the

ANSI test standards, which do not measure some

important properties such as resistance of hard

hats to off-center impacts or of glass safety glasses

to penetration.

NIOSH has not tested these safety devices since

the publication of these reports in the mid-to late1970s. Furthermore, several items of personal

safety equipment, notably clothing and chemicalresistant gloves, were not tested in the NIOSH

program. Whether design and quality control now

are better, about the same, or worse than when

NIOSH performed these tests is not known.

Tests of Gloves Against

Chemical Hazards

Manufacturers, in their literature, rate various

types of gloves as providing “excellent, good, fair,

or poor” protection against workplace chemicals.

There seems to be little reason for the general

assignments of resistance to chemicals. As is

shown on table 8-4, many chemicals penetrate

“chemical-resistant” glove materials quite quickly.

Some workplace solvents, for instance halogenated ethanes (dichloroethanes and trichloroethanes) and polychlorinated biphenyls (PCBs),

have presented special problems because they

penetrate most gloves in minutes or seconds. A

relatively new material, Vitron, developed by Du

Pont, provides excellent resistance to the halogenated ethanes, however, and better resistance

to PCBs than any other tested material. This example illustrates how new developments in technology find application in the protective devices

industry. Yet Vitron gloves may not be used widely because of the high cost—10 times as much as

any other glove.

Involvement of Personal Protective

Equipment in Injuries

There are no field tests of personal protective

equipment used for preventing injuries. It is probably impossible to design such tests, and only
—

Ch. 8—Personal Protective Equipment 167

Table 8-4.—Comparison of Various Protective Garment Materials’ Capacity to

Resist Penetration by Chlorinated Ethanes and PCB

Number of minutes required for solvent to penetrate 1/1,000 inch

of the protective material

1,2-di- 1,1,1-tri. 1,1 ,2-tri - polychlorinated

Protective material chloroethane chloroethane chloroethane biphenyl (PCB)

Butyl rubber . . . . . . . . . . . . . . . . . . . . . 6.4 2.7 2.3 0.1

Neoprene rubber latex . . . . . . . . . . . . 0.9 2.0 0.3 0.02

Nitrile rubber latex . . . . . . . . . . . . . . . 0.3 3.8 0.3 0.1

Polyethylene . . . . . . . . . . . . . . . . . . . . . 1.2 1.5 1.8 0.4

Surgical rubber latex. . . . . . . . . . . . . . 0.2 0.05 0.1 0.04

Vitron . . . . . . . . . . . . . . . . . . . . . . . . . . . 82.0 >144.0 >144.0 6.0

SOURCE Adapted from (456)

workers with a great deal of confidence in their

equipment would submit to having their hard hats

or safety-toe shoes struck by a heavy weight while

their heads or feet were inside. In the absence of

such data, it is useful to inspect the Bureau of Labor Statistics (BLS) reports of accidents involving different parts of the body.

BLS warns that its data do not allow any conclusions to be drawn about the incidence of injuries suffered by workers wearing and not wearing protective equipment, for no information

about exposure is available. For instance, the BLS

data do not reveal if workers wearing protective

eyewear are exposed to more airborne particles

with the potential of harming eyes than are workers who do not wear protective eyewear. Although the BLS data cannot reveal how many injuries personal protection devices prevented, they

can be used to learn about conditions that caused

failure of such devices and why personal protective devices were not worn.

The BLS data were collected over time periods

ranging from 2 to 5 months in 19 or 20 States (depending on the injury studied). Employers’ reports

of injuries to State workers’ compensation agencies were reviewed, and questionnaires were

mailed to workers in selected occupations in all

industries except mining. In general, the survey

period ended when a certain number of questionnaires were returned, and the results cannot be

taken as representative of all injuries affecting the

specified part of the body.

Selected Data From the BLS

Survey of Head Injuries

The head injuries suffered by workers wearing

hard hats were divided about equally among impacts sustained on the hard hat, on an unprotected

area, and both (600) (table 8-5). The shells of 37

percent of the helmets broke, and the suspensions

of 17 percent failed as a result of the accident. An

injury can result, of course, from an impact that

does not damage the helmet. For instance, too

much force can be transferred if the shell is pushed

forcibly onto the worker’s head. The high failure

rate reflected in shell and suspension breakage

parallels NIOSH’s observations that only 33 percent of tested Class B industrial helmets passed

the ANSI impact resistance test.

Table 8-5 presents data on the reasons that hard

hats were not worn. The majority of workers who

were unprotected were not supplied with protective equipment, not required to wear it, or

thought it was unnecessary. Less than 20 percent

of the injured workers who were not wearing head

protection said that hard hats were uncomfortable, impossible to wear, or interfered with work.

The percentage of workers usually wearing

hard hats in their work is very close to the percentage required to do so. Twenty-one percent of

all workers who responded to the BLS questionnaire are required to wear hard hats; 20 percent

wear hard hats all or most of the time. Ninetyfive percent of the workers wearing hard hats at
168 . Preventing Illness and Injury in the Workplace

Photo credit: Department of Labor, Historical Office

Photo credit: Chemical Manufacturers Association

Worker dons full protective suit

the time of their accident were required

them.

Selected Data From BLS Survey of Eye

to wear

Injuries

The most important information for assessing

the effectiveness of eye protection would be to

know how many injuries were prevented by them.

As with head injuries, however, no data are available to calculate that.

Although materials have changed since this photo was

taken, the basic purpose of protective clothing is still

to prevent worker contact with harmful substances

Table 8=5.—Selected Information From BLS

Survey of Head injuries

Number Percent

Workers’ reports of head Injuries while wearing hard hats:

Total . . . . . . . . . . . . ... , . . . . . . . . . 169a

Struck on hard hat area only ., . . 53 31

Struck on unprotected part of

head only , . . . . . . . . . . . . . . . . . . 60 36

Struck on hard hat area and

unprotected part . . . . . . . . . . . . . 55 33

Don’t know . . . . . . . . . . . . . . . . . . . 1 1

Helmet shell broken or

damaged , . . . . . . . . . . . . . . . . . . 40 37

Helmet suspension broken or

damaged . . . . . . . . . . . . . . . . . . . 18 17

Workers’ reports of masons for not wearing hard hats: a

Total . . . . . . . . . . . . . . ... , . . . . . . . 852

Thought it was not needed . . . . . 216 25

Not available from employer . . . . 176 21

Not normally used or not

practical . . . . . . . . . . . . . . . . . . . . 471 55

Uncomfortable, did not fit with

other equipment, hard to work

with it on, or in bad

condition . . . . . . . . . . . . . . . . . . . 163 19

Other . . . . . . . . . . . . . . . . . . . . . . . . 42 5

 responses number of Injuries and sum of 

 100 because multiple responses could be given by single individual.

SOURCE: 
.

Ch. 8—Personal Protective Equipment . 169

Table 8-6 lists the reasons workers thought protective eyewear failed to protect them (598). The

most frequently cited reason was that the object

or chemical that caused the injury went around

or under the protection. NIOSH (94,133) has

drawn attention to this possibility in reports on

piano safety spectacles (which should be equipped

with side shields) and on face protection (which

should not be used without eye protection).

Despite all the caveats that must be attached

to conclusions about the effectiveness of protective eyewear, it can be concluded that few devices

failed because of characteristics for which ANSI

has testing standards. Only 4 percent of the injuries involved lens failures, and only 1 percent

were related to frame breakage.

The reasons given by injured unprotected workers for not wearing eye protection are tabulated

in table 8-6. Twenty-two percent reported that protective eyewear was unavailable at the work site.

The other reasons given were either that the

worker or the worker’s supervisor did not think

Table 8-6.—Selected Information From BLS

Survey of Eye injuries

Number Percent

Workers’ reports of reasons Injury occurred when eye

protection was worn:

Total . . . . . . . . . . . . . . . . . . . . . . . . . 401a

Object or chemical went under

or around protection . . . . . . 376 94

Object went through lens or the

shattered lens hit eye; lens

was knocked out of frame . . . 15 4

Frame broke and injured

worker . . . . , . . . . . . . . . . . . 4 1

Eye or face protection slid or fell

out of place . . . . . . . . . . . . . . . . 16 4

Other . . . . . . . . . . . . . . . . . . . . . . . 28 7

Workers’ reports of reasons for not wearing eye protection.-

Total . . . . . . . . . . . . . . . . . . . . . . . . . 612

Eye or face protection lifted up;

not in place . . . . . . . . 37 6

None available, not required, or

worker thought none needed or

not normally used or 136 22

impractical . . . . . . , . . . 402 66

Protection device reduced vision

or device fogged up, or device

was uncomfortable or in bad

condition . . . . . . . . . . . . . . . . 293 39

Other . . . . . . . . . . . . . . . . . . . . . . . . 63 10

asorne resporlses exceed total number of Injuries and Sum Of Percentages

exceeds 100 because mult Iple responses could be given by single individual

SOURCE (598)

eye protection was necessary or that the eye protection interfered with the worker’s vision.

There is no way to be certain that wearing eye

protection would have reduced the number of injuries to unprotected workers, but it is a safe

assumption that at least some injuries would have

been prevented and that the severity of others

would have been reduced. Apparently greater use

of protective eyewear would result from greater

supervisor attention and improved designs to reduce interference with workers’ vision. Seventynine percent of those wearing eye protection were

required to; only 52 percent of all workers were

required to.

Just over half (56 percent) of the injured workers who were wearing eye protection thought that

it reduced the severity of their injuries. Five percent thought that the protection contributed to

the injury. The remaining 39 percent did not have

an opinion about the effect of the eye protection

or thought that it had had no effect.

Selected Data From the BLS

Survey of Face Injuries

Only 9 of 770 workers who were included in

the survey of face injuries reported that they had

been wearing face shields when they were hurt

(599). However, about a third of the injured workers had been wearing eye protection; about 20 percent of them thought the eye protection minimized

their injuries, and about 10 percent reported facial

injuries from broken frames or lenses.

Most workers who did not wear face protection reported that it was not required or was not

considered necessary. Only about 10 percent reported that it was uncomfortable or interfered

with vision.

The one face shield that failed was split by

fragments of an exploding cutting wheel, which

caused multiple fractures. In five cases, the object or chemical that caused injury went around

or under the face shield.

Selected Data From the BLS

Survey of Foot Injuries

Workers only infrequently wear safety footwear unless required by employers; “fewer than
170 Preventing Illness and Injury in the Workplace

a tenth of those not required to use foot protection were wearing safety shoes” (601). Eighty-five

percent of the workers wearing safety shoes were

injured in an unprotected part of the foot. Importantly, given the ANSI emphasis on testing the

strength of the safety toe, only 7 percent of foot

injury accidents reported to BLS involved safety

toe failures.

As noted earlier, NIOSH (117) observed that

manufacturers sometimes exaggerated the impact

or compression resistance of the safety toe. Evidently users of safety shoes are seldom aware that

the shoes are rated on these features; 82 percent

of workers wearing safety shoes did not know

what class of protection the shoes provided. Fiftyseven percent of workers wearing safety shoes

thought that the severity of their injuries had been

reduced; only 1 percent thought that the shoes

contributed to injury.

Possible Conclusions From the BLS Surveys

The results of the BLS Surveys are consistent

with the conclusion that the equipment works-in

that the failures the ANSI standards are to guard

against occurred infrequently except in the case

of hard hats, which failed relatively often. That

conclusion is necessarily limited. For instance, if

the 7 percent of safety-toe shoes that failed on the

job did so because they received an impact of

much greater force than the shoes were designed

to withstand, then the shoes performed up to the

standard. On the other hand, if some fraction of

the 7 percent failed at an impact less than they

were designed to resist, then the 7 percent failure

rate is an underestimate.

Third= Party Laboratory Testing of

Personal Protective Equipment

Manufacturers of personal protection devices

are not required to test their products. They may

do tests to assure themselves that the products

meet ANSI standards. However, the results of the

(now dated) NIOSH evaluation of personal protective equipment against ANSI standards provides no assurance that such tests are always done

or that quality control is sufficient to guarantee

that products coming off the assembly line meet

the standards.

The Industrial Safety Equipment Association

is the trade association of manufacturers of personal protective equipment. According to its president (672), the association had supported the extension of NIOSH certification programs from

respirators to other personal protective equipment. In 1980, the association, upon deciding that

NIOSH was unlikely to be able to expand its certification program, established as a separate entity the Safety Equipment Institute.

SEI is a testing and certification organization.

It does not develop its own test standards; instead,

as NIOSH did in the late 1970s, it tests equipment

against the ANSI standards. The tests are carried

out in laboratories under contract to SEI. The Institute so far has tested hard hats made by 95 percent of the manufacturers and eye and face protection made by 65 percent of the producers, and

it makes available lists of hard hats and eye and

face protection that passed the ANSI standards

and were certified. Currently it is testing emergency eyewash and shower facilities.

Following the testing phase of the SEI certification procedure, the Institute, through an independent consulting firm, arranges for quality assurance audits of the manufactures of certified

equipment on a biannual basis. In addition, at 6-

or 12-month intervals, SEI retests a number of each

certified model of personal protective equipment.

Upon retesting hard hats, SEI found that all the

tested green-colored hats of one model made by

one manufacturer did not meet the ANSI standards.

Upon being notified of this fact, the manufacturer

withdrew that lot of green hats from the market

and informed all distributors that had purchased

them that the hats were below ANSI standards.

SEI has not been greeted by everyone as an independent source of information about the effectiveness of personal protective equipment. Springing as it did from the trade association, it is seen

by some as under the control of the manufacturers. The Institute has partially addressed this criticism by establishing a board of directors that has

only one -member from the trade association. Its

bylaws also separate it from the trade association.

Although time will have to pass before the success of SEI’s program can be evaluated, the program is now well under way, and it offers third-
Ch. 8—Personal Protective Equipment 171

party certification of personal protective equip- purchaser of certified personal protective equipment. SEI points out that it offers both an alter- ment that the equipment meets national consennative to self-certification and assurance to the sus standards for performance.

SUMMARY

The Federal Government does not certify that

any types of personal protective equipment, except respirators, work. In the case of some other

items of personal protective equipment, the American National Standards Institute has drawn up

standards, and manufacturers advertise that their

products meet those standards.

The procedures used by NIOSH to certify respirators are dated, and there is a great deal of dissatisfaction with them. Even devices that pass the

tests may not work well in the field, and since

there is only a pass/fail evaluation, better respirators receive the same grade as ones that barely

meet the standards.

Few studies have measured the effectiveness of

respirators in the workplace. High effectiveness

has been found only in workplaces that have welldeveloped respirator programs with careful maintenance, education, and supervision.

NIOSH is currently drafting a revision of the

certification regulations, which reportedly will require that manufacturers test and certify their own

products. Not everyone supports self-certification.

Labor unions are in favor of the government

maintaining a role in certification. An alternative

offered by some manufacturers is the establishment of a testing laboratory, supported by industry fees, to carry out the certification tests. Industry is not uniformly behind the idea of a

third-party laboratory, however, because the facility, as proposed, would have ties to some manufacturers. To opponents of the third-party laboratory, those ties mean that it too would be a

method of self-certification, and they favor

straightforward self-certification.

Hearing conservation programs depend on

measuring the level of noise in the workplace,

lowering it when possible by engineering controls,

providing hearing protectors to workers exposed

to noise above certain specified levels, and checking workers’ hearing periodically to determine if

hearing acuity has dropped below prescribed levels. All hearing protectors are labeled with a Noise

Reduction Rating, which is supposed to give the

purchaser information about the amount of protection provided by the protector.

There is almost universal agreement, and no

evidence to the contrary, that the NRRs overstate

the amount of protection afforded by hearing protectors. NRRs are required by a law administered

by the Environmental Protection Agency; because

of budgetary cutbacks, however, EPA is no longer

monitoring the accuracy of NRRs. Therefore,

products bearing a Government-approved efficiency rating are known to be overrated, and that

situation is unlikely to change.

Field testing of hearing protection has yielded

evidence that noise attenuation achieved in the

workplace is much less than that expected from

the NRRs. Some workers, even though they wore

hearing protectors, received no benefit in terms

of noise reduction. On the other hand, a limited

study of hearing acuity in a major chemical company showed that hearing losses among its workers over a 5-year period were not related to noise

levels. Additional, longer studies are necessary,

however, before the success of these programs can

be fairly judged.

Analogous to the situation with respirators, the

usefulness of hearing protectors depends on how

they are chosen and used. A continuous program

of instruction, supervision, and maintenance is

necessary.

In the late 1970s, NIOSH tested several types

of personal protection equipment against the

ANSI standards. Since almost all the equipment

was manufactured by companies that claimed adherence to ANSI standards, the NIOSH tests were

a measure of the quality assurance programs of
172 ● Preventing Illness and Injury in the Workplace

the manufacturers or of their ability to carry out

the ANSI tests.

Some types of safety equipment, notably spectacles, flexible goggles, miners’ helmets, linemen’s

rubber gloves, and face protection, were found

to conform to the ANSI standard against which

they were manufactured. Others—safety-toe

shoes, eyecup goggles, industrial safety helmets

(hard hats), firefighters’ helmets, and welding filter

plates—often did not measure up to the ANSI

standards. Furthermore, some deficiencies were

found in the ANSI test standards, which do not

assess some important properties such as resistance of hard hats to off-center impacts or of glass

safety glasses to penetration.

The Bureau of Labor Statistics has collected

questionnaire data about some industrial accidents. Their survey data about head injuries

showed that hard hats frequently failed in accidents, which fits with NIOSH’s findings that many

hard hats did not meet ANSI standards. Other

Bureau reports found that other types of personal

protective equipment also failed under certain,

sometimes very severe, conditions. However, protective equipment was seldom identified as the

cause of an accident. Although it is impossible to

know how many injuries were prevented by personal protective equipment, it is clear that its use

depends on good design and supervision of its use.
9

Hierarchy of Controls
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Hierarchy of Controls

As explained in chapter 5, a generalized model

of the workplace environment looks at sources

of hazards, transmission of the hazard, and workers (see fig. 5-2 in ch. 5). Health and safety hazards

are controlled by interrupting the transmission of

hazardous agents to workers. Controls can be introduced at several points: the source of the hazard,

the workplace atmosphere (or transmission points),

and the workers’ location(s). For health hazards,

control at the source can include substitution of

less toxic agents or substances, as well as process

and engineering changes to reduce emissions of

the hazardous agents or substances. Control of

transmission of the agent can be accomplished by

ventilation, isolation, dilution, or enclosure. Control at the worker can include personal protective equipment, work practices, and administrative procedures (see discussions in chs. 5 and 8).

This model can also be applied to injury hazards, although much of the safety research published to date has followed other approaches. For

example, control of electrical energy at the source

might involve grounding to prevent the buildup

and inappropriate release of hazardous amounts

of energy. Control of transmission could include

separating workers from the hazard by, for example, placing physical barriers or guards between

the worker and the hazard, Personal protective

equipment, such as insulated gloves, represents

a control applied on the worker.

DESCRIPTION OF HIERARCHY OF CONTROLS

Health and safety professionals have traditionally ranked controls according to their reliability and efficacy in removing or controlling hazards. Put simply, the principle of the hierarchy

of controls is to control the hazard as close to the

source as possible. (This hierarchical approach is

most commonly discussed in relation to health

hazards and the methods of industrial hygiene.

Although the principle can also be applied to safety hazards, most of the discussion in this chapter

will focus on the control of health hazards. )

Expressed differently, the hierarchy of controls

describes the order that either should be followed

or must be followed when choosing among options for controlling health and safety hazards.

In its simplest form, the hierarchy of controls

specifies that engineering controls (including substitution, enclosure, isolation and ventilation) are

preferred to the use of personal protective equipment. Work practices are frequently added to this

list between engineering controls and personal

protective equipment. Administrative controls,

such as worker rotation, are also oftentimes included and generally constitute the “third” line of

defense, falling after engineering controls and

work practice controls and ahead of protective

equipment. For some hazards, however, the Occupational Safety and Health Administration

(OSHA) places administrative controls on an

equal basis with engineering controls. In addition,

OSHA now usually groups engineering controls

and work practices together and assigns them the

same priority. Nevertheless, in all cases, personal

protective equipment is listed as the control of last

resort.

Views of Health Professionals

The hierarchy of controls is widely supported

in the professional community. Every current industrial hygiene textbook endorses the idea of

such a hierarchy and lists engineering controls as

the first priority and personal protective equipment as a last resort (455). It is often expressed

in the context of controlling exposures to airborne

contaminants-fumes, dusts, and vapors-that

175
176 ● Preventing Illness and Injury in the Workplace

may enter the worker’s respiratory system. Elimination of the contaminants by substitution of

materials, enclosure of operations that generate

fumes and vapors, dust suppression methods, or

dilution of the contaminants by ventilation are

all preferred over reliance on respirators. Leaders

in this field and industrial hygiene texts all agree

on this point (129,173,199,362,369,423).

Excerpts from a 1947 textbook on industrial hygiene and from a 1980s text underline the unchanging preference for engineering controls.

Obviously, the most successful approach to the

problem of industrial atmospheric sanitation lies

in the design or alteration of plant and equipment

so that the control features are engineered into the

structure and machinery (71, emphasis in original).

In many instances, however, the reduction of exposure [through engineering methods] is not sufficient to eliminate the hazard, and other control

measures are needed. . , . Respiratory protective devices have a distinct place in the field of industrial

health engineering. That they are a last Zinc of defense can hardly be denied (71, emphasis added).

The newer text states:

If confinement or removal by adequate properly engineered and operated ventilation systems is

not possible, personal protective equipment on a

temporary basis should be considered. We stress

the word “temporary” since respiratory protection can seldom be relied on for long periods of

time in hazardous exposures, unless highly unusual control procedures are established and rigorously enforced (172).

In 1963, the American Conference of Governmental Industrial Hygienists (ACGIH) and the

American Industrial Hygiene Association jointly

issued a comprehensive guide to respiratory protection in the United States. The opening paragraph is clear on the preferred methods of controlling occupational hazards:

In the control of those occupational diseases

caused by breathing air contaminated with harmful dusts, fumes, mists, gases, or vapors, the primary objective should be to prevent the air from

becoming contaminated. This is accomplished as

far as possible by accepted engineering control

measures; . . . (9).

Consensus Standards

The hierarchy of controls is also found in the

“consensus” standards written by committees

meeting under the auspices of the American National Standards Institute (ANSI) and its predecessor, the American Standards Association. The

Association’s 1938 standard for protective equipment did not require any particular “hierarchy of

controls, ” but the attached commentary noted:

It is obviously better to remove the hazard,

when this is possible, than to protect the worker

against it [using personal protective equipment].

Thus, in granite cutting it is preferable to remove

the dust by an exhaust system rather than to allow

it to contaminate the air, and then to protect the

worker against breathing the dust. . . . This code

does not attempt to specify how various industries shall be conducted, with respect to avoiding

hazards, but points out the method of protecting

the worker where the hazard has not been eliminated by other means (15).

In the 1959 revision of this consensus standard,

respirators were assigned a supplemental function

in the actual text of the standard:

General Considerations. Respirators are used

to supplement other methods of control of airborne contaminants rather than to substitute for

them. Every effort should be made to prevent the

dissemination of contaminants into the breathing

zones of the workers. In some instances, it is necessary to use respirators only until these control

measures have been taken; in others, such measures are impracticable, and the continued use of

respirators is necessary (16).

In 1969, ANSI issued a separate standard for

respiratory protection. The heading of the paragraph that describes the applicable principles was

changed from “General Considerations” to “Permissible Practice,” adding weight to the importance of the control hierarchy. In addition, emphasis was given to what was now viewed as the

“primary objective” of workplace controls: preventing the contamination of the workplace atmosphere. In addition the word “feasible” was

used in connection with controls.

Permissible Practice. In the control of those occupational diseases caused by breathing air con-
. .——. ...—

Ch. 9—Hierarchy of Controls ● 177

taminated with harmful dusts, fogs, fumes, mists,

gases, smokes, sprays, or vapors, the primary objective shall be to prevent atmospheric contamination. This shall be accomplished as far as feasible

by accepted engineering control measures (for example, enclosure or confinement of the operation,

general and local ventilation, and substitution of

less toxic materials). When effective engineering

controls are not feasible, or while they are being

instituted, appropriate respirators shall be used

. . . (11, emphasis in original).

The 1980 revision of this ANSI standard is virtually identical in wording, although the phrase

beginning with “the primary objective” is no

longer underscored. In addition, respirators are

now permitted “[w]hen effective engineering controls are not feasible, or while they are being instituted or evaluated . . . “ (12, emphasis added).

Government Standards

The conclusions and practices of the professional community and the consensus standards organizations now have regulatory force. The startup

standards adopted by OSHA in 1971 under the

authority of section 6(a) of the Occupational

Safety and Health (OSH) Act (see ch. 12) included

three specific provisions concerning the hierarchy

of controls.

The applicable paragraph in OSHA’s standard

concerning respiratory protection (29 CFR 1910.134

(a)(l)) was taken, word for word, from the paragraph

in the 1969 ANSI standard quoted above, although the

one phrase underscored in the ANSI standard is not

underscored in the OSHA standard. Second, the

OSHA noise standard requires employers to comply with the permissible exposure limit through

the use of “feasible administrative or engineering

controls” (29 CFR 1910.95(b)(l)).

Finally, OSHA’s main requirement for limiting exposures to toxic substances (the Air Contaminants

standard) reads:

To achieve compliance with . , , this section,

administrative or engineering control must first

be determined and implemented whenever feasible. When such controls are not feasible to achieve

full compliance, protective equipment or any

other protective measures shall be used to keep

the exposure of employees to air contaminants

within the limits prescribed . . . Any equipment

and/or technical measures used for this purpose

must be approved for each particular use by a

competent industrial hygienist or other technically

qualified person. Whenever respirators are used,

their use shall comply with section 1910.134 [the

OSHA respirator standard] (29 CFR 1910.1000

(e), emphasis added).

In addition, in all of its substance-specific proceedings that resulted in new or revised permissible exposure limits, OSHA has maintained a policy of first requiring employers to comply by

implementing “feasible” engineering and work

practice controls. Although the precise wording

of these requirements has differed slightly among

these health standards, the basic outline is clear:

First, an employer must institute feasible engineering and work practice controls to reduce emloyee exposures to or below the permissible exposure limit.

Second, even if the feasible engineering and

work practice controls are insufficient to achieve

compliance with the permissible limit, the employer is required to use them in order to reduce

exposures as low as possible before issuing personal protective equipment.

Personal protective equipment, such as dust

masks, gas masks, and other types of respirators,

is to be used against airborne contaminants in

only four circumstances:

●

●

●

●

during the time period necessary to install

feasible engineering and work practice

controls,

when engineering and work practice controls

are not feasible (including many repair and

maintenance activities),

when engineering and work practice controls

are not sufficient to achieve compliance with

the permissible limits, and

in emergencies.

Controls for Safety Hazards

A similar priority system has been suggested

for the control of injury hazards. A clear exam-
178 ● Preventing Illness and Injury in the Workplace

ple can be found in the National Safety Council’s

Accident Prevention Manual (322), which lists the

following “hierarchy”:

The basic measures for preventing accidental

injury, in order of effectiveness and preference

are:

1.

2.

3.

4.

Eliminate the hazard from the machine,

method, material, or plant structure.

Control the hazard by enclosing or guarding

it at its source.

Train personnel to be aware of the hazard

and to follow safe job procedures to avoid

it.

Prescribe Personal protective equipment for

personnel to shield-them against the hazard.

Discussions about the hierarchy of controls in

these situations is often concerned with the relative priorities to be placed on workplace and machinery design as opposed to worker training. Employee training and education will always be an

important adjunct to any control technique. But

ergonomics and safety research now stress the importance of design over primary reliance on the

inculcation of certain “safe” work routines

through training. (See also discussions of safety

hazard identification, injury controls, ergonomics,

and worker training in chs. 4,6,7, and 10).

Photo credit: NIOSH (photo provided by OSHA,

Office of Information and Consumer Affairs

Because respirators increase the effort required for

breathing and are uncomfortable, workers often do not

wear them or wear them only intermittently. Engineering

cent rots can often eliminate the need to use respirators

ADVANTAGES AND DISADVANTAGES OF THE

HIERARCHY OF CONTROLS

The preference for engineering methods for con- professionals, the National Institute for Occupatrolling workplace hazards is sometimes ques- tional Safety and Health (NIOSH), and OSHA

tioned. Why are engineering controls preferred assigned personal protective equipment to the

and why is personal protective equipment ranked position of being only a ‘last line of defense”? The

lower than other methods? Why have nearly all reasons can be divided into those that deal with
.

Ch. 9—Hierarchy of Controls ● 179

specific, often technical, problems of currently

available personal protective equipment and those

that address more general advantages of engineering controls.

Problems with Personal

Protective Equipment

Many types of existing personal protective

equipment do not provide reliable, consistent, and

adequate levels of protection. Indeed, research

conducted on the real-world or workplace, as opposed to laboratory, effectiveness of such equipment shows that the protection provided by these

devices is unequal, highly variable, and substantially lower than that predicted from laboratory

measurements (see ch. 8). For example, it has been

estimated that the mean real-world attenuation

of hearing protectors is only about one-third their

laboratory attenuation (49). These shortcomings

often make personal protective equipment inadequate for worker protection.

Advantages of Engineering Controls

The problems specific to personal protective

equipment are sufficient to cause professionals to

rank engineering controls above them in the hierarchy of controls. Additionally, engineering controls have a number of advantages ranging from

the relatively mundane and pragmatic to the more

philosophical.

In brief, engineering controls are inherently

more reliable and provide more effective protection than personal protective equipment and are

more likely to result in successful hazard control

(see box G). Once installed and adequately maintained, engineering controls provide reliable and

consistent performance, and, if designed correctly,

adequate levels of protection.

Engineering controls work day after day, hour

after hour, without depending on human supervision or intervention. Because they do not depend on a “good fit” with workers, they provide

the same protection to all, and monitoring devices

can measure the protection afforded. Separated

from contact with the worker, engineering controls do not create additional health or safety

problems, Moreover, these controls, especially

those at the source of a hazard, can simultaneously control several exposure routes, such as respiratory and dermal exposure, while protective

equipment is generally limited to protecting only

one exposure route.

In addition, OTA has identified five other areas

for which engineering controls have advantages

over personal protective equipment. First, many

employer-provided personal protective programs

are currently inadequate. Most discussions of the

relative merits of engineering controls and personal protective equipment center on respiratory

hazards. For those hazards, it is argued that respirator programs can be designed and implemented to provide protection equal to that afforded by engineering controls. Successful control

through the use of respirators has sometimes been

achieved by a few, usually large, employers who

have sophisticated health and safety programs.

But not all employers have implemented such programs or are capable of doing so.

Indeed, failures in employer respirator programs are the most frequent cause of OSHA citations in health inspections, reinforcing the experience of many industrial hygienists and OSHA

inspectors that most existing respirator programs

are inadequate. More than one-third of all OSHA

citations for violations of health standards involved the respirator program requirements,
180 . Preventing Illness and Injury in the Workplace

which were directly adopted from the 1969 ANSI

consensus standard (180).

Former OSHA inspectors have written that, in

their experience, for most cases of employee overexposure to air contaminants the employers’ respirator programs were inadequate (329,363). This

is supported by analysis of OSHA inspection data.

OSHA inspectors cite violations of the respirator program requirements in 40 to 70 percent of

the inspections in which employee overexposure

was measured (402). A leading consultant in the

field has summarized his experience:

having reviewed the respirator programs of

hundreds of private companies, I can state that

I have not, with the exception of the nation’s very

largest corporations, ever observed a proper and

adequate use of respirators in the occupational

setting (309).

Second, it is generally impossible to make periodic measurements of respirator efficiency, and

it is very difficult to monitor each individual employee as he/she cleans, dons, and uses his/her

respirator. Moreover, it is probably human nature

to be on one’s “best behavior” when someone is

“watching. ” It is therefore difficult to be certain

that the use of equipment observed by a respirator program manager is representative of regular

use. Similarly, it is much more difficult for OSHA

to monitor the use of masks and respirators during an inspection, which are conducted infrequently, and to be certain that the use observed

then is representative of use on other days.

Third, in a hierarchical approach, with control

achieved close to the source of the hazard, there

is room for backup or supplemental controls. For

example, if the primary control involves the use

of process containment (“control at the source”),

then this control can be supplemented by having

personal protective equipment available (“control

at the worker”) for emergency use. If the primary

control is protective equipment, the opportunity

to provide for supplemental control is eliminated

because the control selected is already “at the

worker”; that is, the last line of defense has

already been used.

Fourth, primary reliance on engineering controls can spur the advance of technology. The

OSH Act allows the agency to mandate “technology-forcing” controls (see ch. 14). New control

technology can be, and has been, accompanied

by other changes in plant and equipment that improve productivity, as well as protecting worker

health and safety (see ch. 16). Relying on personal

protective equipment would reduce technological development—including the development of

controls that may find application to other

hazards, as well as improvements in equipment

that reduce hazards and simultaneously raise productivity. For example, if OSHA had permitted

the use of dust masks to comply with the cotton

dust standard, the installation of new technology

in the cotton textile industry would probably not

have taken place as rapidly as it did. Modernized

equipment has both dramatically improved productivity and lowered worker exposures to cotton dust (413).

Finally, personal protective equipment is burdensome on employees. It is usually uncomfortable,

decreases mobility, and the weight of many types

of personal protective equipment increases employees’ physical work loads. Negative-pressure

respirators, in addition to their discomfort, also

significantly increase the effort needed for breathing. This can create special difficulties for workers who have already suffered lung impairments.

Moreover, this equipment often impairs productivity. In many cases workers are paid on a “piecework” basis or are evaluated on how well they meet

employer-set productivity standards. If allowance

is not made for the decrease in productivity due to

the use of protective equipment, an economic burden may be borne by the employee.

The use of such equipment, especially respirators,

also impairs communication and worker-to-worker

contact. This may lead to additional safety problems because employees wearing respirators will be

unable to warn each other of potential safety hazards, while those wearing hearing protection may

be unable to hear instructions, warning signals, or

changes in the operations of plant equipment. (However, one study has found decreases in accidents

after implementation of a hearing conservation program (622).) In addition, reducing worker-to-worker

communication can increase a person’s sense of

isolation and detract from the important social functions of work.
Ch. 9—Hierarchy of Controls ● 181

Lastly, workers required to use personal protective equipment may feel that they are no longer being treated as persons, especially if they are not

allowed to participate in any decisions concerning

the use of equipment. People in this position may

feel that they are merely cogs in the workplace, similar to other machines that require hoods, filters, and

masks.

Problems with Engineering Controls

Notwithstanding the advantages of engineering controls over personal protective equipment,

there are some drawbacks. First, although they

are less subject to human error and inherently

more reliable, engineering controls can fail. No

matter how well designed, a ventilation system

will fail to remove an airborne contaminant if the

fan stops. Although these failures can be kept to

a minimum with adequate maintenance, respirators must be available for use in such emergencies.

Even substitution does not eliminate the possibility of a failure in hazard control. For example,

carbon tetrachloride, which had been used as a

substitute for petroleum naphtha, is now widely

recognized as toxic itself. Some of the substitutes

for carbon tetrachloride (tricholoroethylene, perchlorethylene) are now suspected of having various previously unrecognized toxic effects.

Second, there are a number of situations for

which feasible control methods have not yet been

fully developed. In these situations, the best that

can be done is to require the use of personal protective equipment while attempting to develop

feasible engineering controls. In addition, such

equipment will always be needed when engineering controls are insufficient to reduce exposures

to permissible levels and during the interim period

while engineering controls are being designed and

implemented.

These situations are widely recognized and are

provided for in OSHA’s hierarchy of controls.

There are, and will be, however, disputes about

what kinds of controls are “technologically feasible” in any given situation. This is particularly

true when OSHA issues a regulation that “forces”

technology, either by speeding development of

Photo credit OSHA Office of Information and Consumer Affairs

Engineering controls for occupational noise exposures

include the use of sound dampening enclosures

control techniques or by facilitating dissemination of existing techniques.

Cost is the principal objection to requiring engineering controls. Although a well-designed and

well-conducted respirator program can be expensive, such programs are in many cases cheaper

than engineering controls and certainly capital

costs are lower. Sometimes the concern about the

costs of engineering controls arises because of the

belief that these costs would be infeasible for a

particular firm (leading to a plant closing) or for

an industry as a whole. Sometimes arguments are

based on the relative “cost-effectiveness” of

controls.

Some employers and economists have suggested

that employers should be allowed the flexibility

to choose among the available control methods,
182 ● Preventing Illness and Injury in the Workplace

rather than being required first to install feasible

engineering controls. This flexibility would allow

employers to choose the least-costly control method.

For example, in its reconsideration of the lead

standard, OSHA estimated the compliance costs

for a group of industries. If these industries were

required to use engineering controls, total annual

Costs were estimated to be nearly $130 million.

But if respirators were allowed, the costs would

be about $78 million (626).

A second example concerns compliance costs

for reducing asbestos exposures from 2 fibers/

cubic centimeter to 0.5 fiber/cubic centimeter. The

total annual costs for all industries, in 1982

dollars, are estimated to be about $134 million

if engineering controls are required and $54 million if respirators are allowed. If the permissible

limit is set still lower, at 0.2 fiber/cubic centimeter, the annual costs would be about $170 million for engineering controls and $56 million for

compliance through the use of respirators (647).

For both examples, there are limitations to the

accuracy of these estimates. Moreover, in neither

case was OSHA able to estimate the potential reduction in worker productivity due to the interference caused by respirators. But, as estimated, the cost differences between these control

methods appear, in many cases, to be substantial.

Many employers believe that the use of personal protective equipment can provide adequate employee protection at reduced cost. This argument

is used with regard to both full 8-hour exposures

and for brief and intermittent exposures. These

industry representatives argue that if the degree

of protection offered by the equipment is equivalent to that provided by engineering controls, it

would be sensible to choose the least costly means.

Unfortunately, as already noted, many kinds of

protective equipment have not been demonstrated

to be effective in actual workplace conditions. In

addition, there may be additional benefits from

requiring engineering controls, such as increases

in productivity or relative decreases in absenteeism. These economic benefits need to be considered when judging the “cost-effectiveness” of different control techniques.

The cost-effectiveness argument is also raised

in connection with the requirement that feasible

engineering controls be installed even when engineering and work practice controls are insufficient

to achieve compliance. In these situations personal

protective equipment is needed for workers in order to meet permitted exposure levels. It is argued

that in such cases expenditures for engineering

controls are wasted because personal protective

equipment will still be required. But because personal protective equipment often fails, reducing

contaminant levels through the use of engineering controls minimizes the likely degree of worker

overexposure.

OSHA’S POLICY TOWARD THE HIERARCHY OF CONTROLS

Since its creation in 1971, OSHA has enforced

the provisions of the startup standards requiring

the use of engineering controls. In addition, OSHA

has developed, through rulemaking proceedings,

new or revised standards covering a number of

toxic substances or hazardous physical agents.

In these proceedings, nearly every health and

safety professional, irrespective of whether the

person worked for an employer, a trade association, a labor union, a public-interest group, a

university, or the Government, agreed that engineering controls are preferable to the use of personal protective equipment. Many of these same

professionals, and other representatives of employers’ and trade associations, would then explain why this general policy did not apply to their

own workplaces or industries. Representatives

from labor unions, public-interest groups, and

Government would carefully argue in reply that

the preference for engineering controls was necessary to protect employee safety and health.

The requirement that regulatory agencies perform “economic impact assessments” (see ch. 14)

has resulted in economists becoming directly in-
Ch. 9—Hierarchy of Controls ● 183

volved in discussions concerning health standards.

The Council on Wage and Price Stability advised

OSHA, on a number of occasions, to change its

policy and allow the use of personal protective

equipment in place of engineering controls. In

each proceeding on health standards before 1981,

OSHA rejected that advice and continued to require engineering controls as the first line of defense for controlling exposures to air contaminants.

Actions by the Current Administration

In February 1983, OSHA published an Advance

Notice of Proposed Rulemaking announcing that

it was conducting a review of the hierarchy of controls and requesting information and comments

from the public. OSHA stated that its objectives

were to:

●

●

●

●

Explore whether a revised policy will allow

employers to institute more cost-effective

compliance strategies.

Investigate whether advances in respirator

design, technology, and applications may

permit increased reliance on respirators.

Attempt to identify processes, operations,

and circumstances appropriate for particular compliance strategies.

Assess actual workplace conditions and employee health in industries and operations

employing different compliance strategies

(639).

During the comment period that followed this

announcement, OSHA received 132 separate comments from the public, including employers, trade

associations, labor unions, and individuals. Employers and their representatives supported a general change in OSHA’s policy, and asked that the

agency allow the use of respirators to substitute

for engineering controls. There were some differences among employers and trade associations

concerning the precise circumstances under which

such a substitution should be permitted, but

nearly all were in favor of allowing employers

flexibility to choose between engineering controls

and respirators. Labor unions, on the other hand,

voiced support for the existing policy and objected

strongly to any changes.

NIOSH, in its comments, supported the hierarchy of controls:

Each element of the hierarchy: 1) preventing

emissions at their source, 2) removing the emissions from the pathway between the source and

the worker, and 3) control at the recipient, should

be applied in descending order to the extent feasible before the next lower element is applied

(585).

Health and safety professionals working for

universities and government agencies supported

the preference for engineering controls. The two

associations of professional industrial hygienists

(the American Conference of Governmental Industrial Hygienists and the American Industrial

Hygiene Association) supported the concept of

first using engineering controls:

The elected Board of Directors of the [ACGIH]

. . . unanimously endorses continuation of the

current [OSHA] policy to require employers to

use feasible engineering controls, work practices,

and administrative controls to prevent employee

exposures above permissible levels. Personal protective equipment, including respirators, may be

used as alternatives only when other methods are

not adequate, are not feasible, or have not yet

been installed. Furthermore, we endorse engineering controls as the preferred approach (125).

The AIHA would like to go on record as stating

that the elimination of workplace hazards is

superior to the use of engineering controls, personal protective equipment, and other control

strategies. Where elimination is not feasible, engineering and other control strategies should be the

primary methods for reducing or eliminating exposures in the workplace. However, personal protective equipment may be necessary pending more

long-term solutions, We recognize that there are

times where personal protective equipment is ultimately the only feasible control. The decision

to recommend engineering controls, personal protective equipment or other control strategies depends on the nature of the hazard in question and

should be based upon the professional judgment

of an industrial hygienist (375).

At this time, OSHA has not yet publicly announced what course it will follow concerning the

general hierarchy of controls policy. in light of

OSHA's reconsideration of the hierarchy of con-
184 . preventing Illness and Injury in the Workplace

trols, the advisory panel for this OTA assessment

asked to be recorded as endorsing the hierarchy

of controls. To turn away from the hierarchy of

controls without careful verification of the level

of protection afforded by personal protective

equipment is likely to increase exposures to health

hazards.

In several substance-specific standards, the current administration has both continued the traditional policy and proposed changes. In its reconsideration of the cotton dust standard, OSHA

decided to continue to require engineering controls, even in the face of objections from the Office of Management and Budget (OMB). This dispute between OSHA and OMB was, at least

temporarily, resolved in OSHA’s favor and the

published proposal reiterates the hierarchy of controls (641).

However, in a proposal concerning a new

standard for ethylene dibromide (EDB), OSHA

proposed for the first time to make an important

exception to the traditional hierarchy of controls,

although this exception would be limited to cases

of intermittent exposure. The agency’s proposal

would allow employers to use respirators as the

primary means of control “where exposure to EDB

. . . is intermittent [defined as an operation that

results in exposures occurring for 1 or 2 days at

any one time] and occurs less than a total of 30

days per year” (642).

In its 1984 proposal for a new asbestos standard, the agency proposed that employers be allowed to use respirators on a continuous basis as

the primary means to comply with a new, reduced

exposure limit. Employers would still be required

to use feasible engineering and work practice controls to meet the current existing limit (2 fibers/

cubic centimeter). But they would be allowed to

use personal protective equipment on a continuous basis to reduce exposures from the 2 fibers/

cubic centimeter limit to the new permissible exposure limit (either 0.5 or 0.2 fibers/cubic centimeter) (647).

In its 1984 final rule reducing the permissible

exposure limit (measured as an 8-hour time-weighted

average) for ethylene oxide exposures, OSHA requires employers to comply with the new permissible exposure limit through the use of feasible

engineering and work practice controls. OSHA

also concluded that most operations that generated short-term exposures to ethylene oxide could

be controlled with the use of engineering controls.

Thus, the agency did not, as it proposed for ethylene dibromide, allow the general use of respirators for all short-term operations with ethylene

oxide exposures (649). (However, because of objections from OMB, the agency did not issue any

short-term exposure limit for ethylene oxide, but

requested public comments on the need for such

a limit and the feasibility of a short-term exposure

limit without the use of respirators.)

In addition, OSHA concluded that for some situations, engineering controls to meet the 8-hour

time-weighted average for ethylene oxide were not

feasible and, for the first time in any health standard, specifically lists those operations in the text

of the regulation. For those situations, employers

are allowed to issue respirators as the primary

means of control (649).

Moreover, the current administration has also

issued an administrative directive to OSHA inspectors, ordering that no citations concerning

OSHA’s permissible exposure limit for noise be

issued to employers who had issued and required

the use of hearing protectors by employees exposed to levels up to 10 decibels (dB) above the

permissible limit (that is, exposures between 90

dB to 100 dB) (646). Because of the logarithmic

nature of the decibel scale, this difference of 10

decibels is equal to a tenfold increase in permissible exposures. One researcher has estimated that

using hearing protectors instead of engineering

controls for noise exposures between 90 dB and

100 dB will double the probability that an exposed

worker will incur an occupational hearing loss

(165).

Finally, OSHA first granted and then withdrew

an experimental variance from the medical removal protection provisions of the lead standard. The

lead standard requires that employees whose

blood lead levels exceed certain specified limits

must be transferred to jobs with little or no exposure to lead. The variance would have allowed

one employer to issue respirators to several employees with blood lead levels above the permitted

limits, who would then continue in lead-exposed

jobs instead of being transferred to positions without lead exposures (243,338,349).
. —

Ch. 9—Hierarchy of Controls ● 185

CONCLUSION

In summary, OTA finds the hierarchy of controls to be a well-founded and protective concept.

Applicable to both health and safety hazards, the

hierarchy is derived from the experience of health

and safety professionals and has been embodied

for years in consensus standards, professional

practice, and OSHA regulations. Engineering controls are more likely to meet the essential requirements for hazard control, and personal protective equipment is a last line of defense to be used

when engineering controls are infeasible, insufficiently protective, or not yet installed. The problems of personal protective equipment arise out

of 1) limitations in performance, 2) difficulties in

evaluating their performance, 3) problems associated with their use, and 4) the physical and other

burdens they create. Moreover, engineering controls are preferred on more general grounds because most personal protective equipment programs are inadequate and because engineering

controls allow easier monitoring of performance

by employers, employees, and OSHA. In addition, these controls are inherently more reliable

and do not create employee burdens, and requiring them enhances the development of new controls and production technology.

OSHA’s reevaluation of its longstanding policy favoring engineering controls for airborne contaminants may indicate a shift in the agency’s approach to the hierarchy of controls. That policy

has led to improvements in the health of U.S.

workers and has spurred, at least to some extent,

the development of control technologies. Policy

changes that allow greater use of personal protective equipment may endanger the health and

well-being of many American workers and reduce

the regulatory imperative to develop new and better production and control technologies.
10.

Training and Education for

Preventing Work-Related

Injury and Illness
Contents

Worker Training and Education . . . . . . . . . . . . . .

Fundamentals Programs. . . . . . . . . . . . . . . . . . . .

Recognition Program$ . . . . . . . . . . . . . . . . . . . . .

Problem-Solving Programs . . . . . . . . . . . . . . . . .

Empowerment Programs . . . . . . . . . . . . . . . . . . .

Evaluation of Worker Training and Education

Occupational

Continuing

Curriculum

Planning..

Safety and Health Professionals . .

Education . . . . . . . . . . . . . . . . . . . . . .

Development and Dissemination .

. . . . . .,..,, . . . . . . .6... < . . . . . . . .

Training Grants. . . . . . . . . . . . . . . . . . . . . . . . . . .

Educational Resource Centers . . . . . . . . . . . . . . .

Programs . . . . . . . . . . . . . . . . . .

Other Training Programs for OSH Professionals . . . . . . . . . . . . . . . . . . . . . . . . .

 Engineers and Managers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........6

Educating Engineers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Training Business Managers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Computer Networks as an Educational Tool. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

NIOSH Use of Computer Networks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Privacy andTrade Secret Concerns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

The Future of Computer Exchanges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,.,

Summary . . . . . . . . . . . . . . . . . . . . . . . .

Figure No.

1o-1. Effect of Funding Changes on Numbers of Graduate Degrees Granted

and Continuing Education Courses Provided by Both NIOSH and

Grant Supported Universities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Page

189

190

191

191

191

194

195

195

195

197

198

198

198

199

199

199

200

200

201

201

201

196

. .

.,
. . ——

10.

Training and Education for Preventing

Work-Related Injury and Illness

Worker training in injury and illness prevention is provided by many employers; it can range

from rudimentary instruction about “safety rules”

to sophisticated instruction about potential hazards and technologies for their control. Training

was at management’s discretion until the Occupational Safety and Health Administration (OSHA)

included training requirements as part of several

regulations. Unions have rarely had the resources

to train members in preventing work-related injury and illness. However, some unions now have

(or had) training programs for their members supported by funds from the OSHA New Directions

program (see ch. 12). OSHA is the Federal agency

primarily responsible for worker training.

The National Institute for Occupational Safety

and Health (NIOSH) is primarily responsible for

educating occupational safety and health professionals. NIOSH, especially through its funding of

Educational Resource Centers (ERCs), has emphasized interdisciplinary education of occupational

physicians and nurses, industrial hygienists, and

safety engineers,

Responsibilities of NIOSH and OSHA overlap.

For instance, NIOSH publications are used in

worker training and the OSHA Training Institute

trains professionals in short courses about OSHA

regulations.

The importance of managers and engineers in

identifying and controlling workplace hazards has

led some professional organizations to discuss

educational needs of their members. Both NIOSH

and OSHA are participating in developing short

courses for these professionals.

It is difficult to measure the effects of training

and education programs. Ideally, decreases in illness and injury rates would be associated with the

programs, but the rates are influenced by so many

factors that clear conclusions are difficult. Currently most measures of success are “process measures” that count the number of students taught

or hours of instruction provided.

WORKER TRAINING AND EDUCATION

Workers trained to recognize and avoid hazards

are an indispensable part of creating and sustaining an illness- and injury-free workplace. In this

assessment, worker training is defined as instruction in recognizing known hazards and in using

available methods of worker protection. Such

training, for example, emphasizes physical procedures and skills, such as keeping a shop floor

free of debris, proper attention to the locking of

machinery during maintenance, or proper use and

cleaning of respirators.

Worker education is defined as instruction in

analyzing and responding to new circumstances

and unforeseen problems. It prepares the worker

to identify potential hazards, to request and collect information about hazards, and to seek ways

to eliminate or control hazards.

Although the boundary between training and

education programs is often vague, the various

programs may be described in four major and

logically related categories: fundamentals, recognition, enforcement, and empowerment (227). In

general, the narrower the role the worker is expected to assume, the more instruction is “training.” The broader the role, the more instruction

is “education .“

189
Since a comprehensive analysis of worker training and education programs, their effectiveness,

and the resources devoted to them is lacking,

OTA contracted with INFORM to survey 40

worker training and education programs. Respondents included 8 business firms and trade

associations, 10 unions, 4 hospital-based programs, 8 university-based programs, 6 Committees (or Coalitions) for Occupational Safety and

Health (COSH groups), and 4 miscellaneous educational programs.

Fundamentals Programs

“Fundamentals” worker training programs instruct about known hazards in order to prevent

work-related illness and injury. Such training may

instruct workers in:

* prevention of work-related injury and illness

through the proper use and maintenance of

●

●

●

.•

O f

potentially hazardous tools, equipment, and

materials;

emergency procedures;

personal hygiene as related to use of hazardous materials;

the need for medical checkups or examinations; and

use of protective devices such as masks,

respirators, safety goggles, or gloves during

nonroutine maintenance, where protective

engineering methods have not yet been implemented, or during emergencies (227 and

see box H).

the five “fundamentals” programs in the

INFORM survey, three were operated by business

firms and two by trade associations. Four teach

supervisors, occupational safety and health

specialists, or other “keypersons” to convey information and skills to workers. In the fifth case,

the health and safety staff of a company instructs

both workers and supervisors. The program ob-
Ch. 10—Training and Education for Preventing Work. Related Injury and Illness ● 191

jective most frequently cited was to reduce costs

of work-related injury and illness.

Recognition Programs

“Recognition” programs prepare workers to

participate in a broader range of worksite safet y

and

●

●

●

●

●

●

health activities through:

emphasizing awareness of the hazards present in the workplace;

understanding different methods available for

hazard elimination or control;

understanding rights and responsibilities

under the law, e.g. right-to-know laws;

collecting information about workplace hazards, e.g. chemical identity of workplace substances, symptoms associated with exposures, exposure levels;

observing or informally inspecting the workplace for potential hazards; and

reporting hazards or potential hazards to

appropriate individuals or committees (227

and see box I).

Of the 14 “recognition” programs in the survey, 3 are conducted by businesses, 5 by unions,

3 by universities, and 3 by hospitals; their major

objective is to teach workers to recognize hazards.

Problem-Solving Programs

The general objective of “problem-solving” programs is to provide workers with the information

and skills necessary to participate in hazard recognition and control. These programs prepare

workers to:

. help solve problems that may arise on the

shop floor, in an ongoing, regular way, by

use of union and management resources and

mechanisms; and

● exercise legal rights when necessary and practical, to bring outside agencies, especially

OSHA and NIOSH, into the workplace to

help address hazards (see box J).

In order to be effective, workers must learn to:

● question work processes and materials to

assess whether hazards have been adequately

identified; and

● judge the effectiveness of alternative methods of control (227).

Of the 14 “problem-solving programs” included

in the survey, 5 are administered by unions, 5 by

universities, 1 by a hospital, and 3 by independent educational programs. The major program objectives emphasize teaching workers to use particular mechanisms to address workplace problems.

Empowerment Programs

“Empowerment” programs aim to teach workers the broadest range of skills so as to involve

them in defending and expanding their rights to

an illness- and injury-free workplace. The major

assumption underlying “empowerment” programs

is that the goals of cleaning up hazardous worksites and ensuring the health and safety of workers requires a substantial transfer of political and

economic power to workers and their unions. To

help educate workers to play a broad social and

political role, “empowerment” programs must either instruct workers in the entire range of skills

and knowledge offered by “fundamentals,” “recognition, ” and “problem-solving programs’’—or

they must work to ensure that such training is provided to workers by unions and/or management

(See box K).

Although INFORM (227) did not collect information about employers’ responses to “empowerment” programs, it is expected that those programs would be opposed. The transfer of political

and economic power from employers and managers in any area, including safety and health, would

be a dramatic shift.

Six of the seven “empowerment” programs in

the survey are conducted by Committees or Coalitions for Occupational Safety and Health. The

other is conducted by a nonprofit educational program. The political focus of “empowerment” programs is apparent in the following descriptions

of program objectives listed by four groups from

the

●

●

survey:

empower workers to deal with problems at

work;

build on hazard recognition and problemsolving skills to give safety committee mem-
192 ● Preventing Illness and Injury in the Workplace

— —
—.

Ch 10—Train/ng and Education for Preventing Work-Related Injury and Illness ● 193

— .

IBPAT reports that its program has had a significant impact on collective bargaining. According

to an IBPAT evaluation of its fiscal year 1982 activities, 5 out of 10 locals or district councils that completed

the IBPAT program prior to negotiations of their contracts secured provisions for health and safety

committees. Among affiliates that did not receive IBPAT instruction, only 3 out of 10 secured such

committees.

The IBPAT program evaluation also showed that 27 percent of those affiliates that have completed

the program won provisions for training programs in their new contracts. This compares with only 10

percent of affiliates that had not undertaken the program. (Both measures of success are complicated

because the affiliates who participated in the program may have already made significant commitments

to safety and health. If that were so, participation and success in negotiations might be better characterized

as two successes stemming from overall commitment rather than any cause-effect relationship. )

Source: (227).

Box J.—Example of a Problem-Solving Program:

Labor Occupational Health Program (LOHP) at the University of California, Berkeley

LOHP offers a variety of programs and services, including:

.

1. formal education and training courses;

2. workshops and conferences;

3. plant walk-throughs to assist in hazard identification;

4. off-site technical advice;

5. legal advice;

6. assistance in collective bargaining; and

7. maintenance of a resource center for public use.

In 1982, LOHP instructed more than 800 workers and union officials through courses, workshops,

and conferences and provided educational and training materials to 4,000 workers and union officials.

In addition to providing instruction typical of “fundamentals” and “recognition” programs, LOHP

places special emphasis on teaching the problem-solving skills listed in the chart below:

Problem-solving programs convey information LOHP offers the following programs that

and skills to workers that enable them to: instruct workers and union officials in problemsolving skills:

1. take an active role in seeking solutions to 1. training for participation in joint committees 

problems on the shop floor (such as an annual course for the Oil, Chemical and Atomic Workers International Union ,

and petrochemical companies in the Berkeley

area)

a conference on workers’ compensation for

workers and trade unionists

workshops on “Collective Bargaining on

Health and Safety”

steward training sessions in health and safety ‘

for unions

Z. exercise legal and contractual rights and 2. a conference on California right-to-know

ensure management compliance with laws law, attended by 150 union and management

and contractual agreements representatives, professionals, and students

small workshops to aid in the implementation

of the state right-to-know law

Source: (227).
194 . preventing illness and Injury in the Workplace

●

●

bers and local union officials and stewards

skills in observing and interpreting air monitoring and medical tests; track trade names

of potentially hazardous chemicals; devise

engineering control methods; negotiate effective health and safety contract language;

empower workers and their unions to win illness- and injury-free working conditions;

have more control over their working conditions; and

empower workers with the skills and the confidences they need to prevent work-related

illness and injury in their workplaces through

collective action (227).

Evaluation of Worker Training and

Education Programs

Ideally, effectiveness of worker education and

training programs would be measured by reduced

job-related injuries and illnesses. However, the

data currently available are often limited, especially for illnesses (see ch. 2). In addition, even

with the appropriate data, attribution of improvements to one factor requires knowledge of all

other factors that might have an effect. In practice, effectiveness measures are generally indirect

and include counting the number of workers

trained or educated and surveying workers’ and

management’s perceptions of the value of the

programs.
Ch. 10—Training and Education for Preventing Work-Related Injury and Illness . 195

OCCUPATIONAL SAFETY AND HEALTH PROFESSIONALS

Congress recognized the need for training a

cadre of occupational safety and health professionals to reach the objectives of the Occupational

Safety and Health (OSH) Act of 1970. Section 20

of the Act designates NIOSH as the agency to plan

for and carry out programs to assure an adequate

supply of professionals. NIOSH was given authorit y to conduct programs for this purpose directly,

through grants, and through contracts.

Since 1971, NIOSH has conducted short-term

training programs for occupational health and

safety professionals, developed curricula and

training materials, and provided grants to universities. Through a grant program, it has established

Educational Resource Centers to train occupational safety and health professionals through

interdisciplinary programs, to provide consultation and training for workers and employers, and

to conduct research related to worker health and

safety. NIOSH has also provided financial support to students through training grants to qualified universities (588).

In addition to NIOSH courses, large companies

sometimes train their own professionals. A cooperative agreement between General Motors and

the United Auto Workers to train union safety

stewards is described in chapter 15.

Continuing Education

NIOSH conducts technical training courses for

private-sector and Government professionals and

technicians. The cost of the training courses is paid

by reimbursements to NIOSH. Short-course topics include:

. industrial hygiene;

. occupational safety;

. industrial toxicology;

● occupational health nursing; and

● occupational medicine.

Special custom courses are produced to meet

specific training needs identified by Government

and private sector groups. For example, in fiscal

year 1982, courses were presented to the U.S.

Navy about analyzing asbestos samples taken during ship refitting; to the Health Departments of

New Jersey and Arizona to train state officials in

the recognition of workplace hazards; to the Mine

Safety and Health Administration Training Academy to provide information about industrial hygiene sampling and analysis for mine inspectors;

and to Case Western University to train science

department faculty in preventing injuries in laboratories.

Between 1977 and 1981, continuing education

enrollment increased from approximately 1,600

to over 10,000 per year (fig. 10-1). At this rate,

enrollment could eventually increase to 50,000 per

year if each specialist in the field attended one continuing education program at least every other

year. As figure 10-1 illustrates, the number of

attendees in continuing education courses increased with funding from 1976 to 1980.

However, a substantial reduction in the number of attendees was projected, based on an

assumption of a lack of Federal funding of ERCs

in the 1984 Presidential Budget (102). In fact,

funding was continued by Congress and the number of trainees is now estimated to be 14,000 per

year. The demand for continuing education increased dramatically as OSHA and NIOSH resources for disseminating information to professionals were cut. This is partially because

graduated professionals sought to update their

knowledge and skills. Funds have been available

to meet this demand due to the flexibility of ERCs

in rebudgeting funds intended for graduate training, where enrollment has been declining.

Curriculum Development and

Dissemination

Refinement and modernization of curricula for

short-term and continuing education can improve

the effectiveness of occupational safety and health

training. One way NIOSH disseminates recent research findings that may help prevent workrelated illness and injury among high-risk groups

is through the development of curricula. Generally this approach consists of identifying groups

who have access to high-risk workers, developing materials that will train these target groups

in recognition and means of prevention of harm,

and conducting “training-the-trainer” programs

so these groups can transfer the knowledge.
196 . preventing Illness and Injury in the Workplace

Figure 10.1 .—Effect of Funding Changes on Numbers of Graduate Degrees Granted and Continuing Education

Courses Provided by Both NIOSH and Grant Supported Universities

747 781 743 Based on ERC

directors’ forecast

and funds reinstated by

congress

800 -

Annual 600

graduate 432

degrees 400

granted 217

200

Based on ERC

directors’ forecast

and no federal funds

1976 1977 1978 1979 1980 1981 1982 1983 1984

(est)

14,0 14 r Estimated following

12

10 -

8 “

6 “

4

2 “ 1.5

1976

reinstatement of

funds by congress 10.5

9.8 Annual number

of attendees

in continuing

education

courses

(thousands)

7.9

4.4

Based on ERC

directors’ forecast

and no federal funds

1983 1984

(est)

1977 1978 1979

9.4

1980

12.9

1981

8.7

1982

12-

10

8 -

6 “

4 2.9

0 ’

1976

Reinstated

 by congress Annual

training

funds

($ million)

7.0

President’s 1984 budget

1978 1979 1980 1981 1982 1983 1984
Ch. 10—Training and Education for Preventing Work-Related Injury and Illness ● 197 —

An example of curriculum development is the

joint NIOSH-OSHA program for instructing vocational education teachers how to teach skills in

recognition and control of workplace hazards. Introducing such concepts to new workers before

they are employed is especially important since

young workers are at the highest risk of traumatic

injury. Pilot programs were conducted with over

100 vocational education administrators and

teachers in Ohio, California, Minnesota, Arizona,

Florida, and New York. The program was designed for flexibility so that its 17 units can be

taught over 3 days or over longer periods, depending on individual needs.

Another example of training-the-trainer was the

NIOSH program to increase the awareness of high

school science teachers about hazards in the working environment. In a three-year period, over

100,000 teachers were trained through this program at a cost of little more than $1 per trainee.

This program also resulted in changes that described chemical hazards to workers in a recently

published high school science text.

Specific teaching modules have also been developed and made available to appropriate groups.

For example, audiovisual presentations on safe

removal of asbestos from school buildings were

developed jointly by NIOSH, OSHA, the Environmental Protection Agency, and the National

Cancer Institute. Over 1,000 copies of these programs were distributed to train asbestos removal

contractors. In another case, videotape programs

were developed to instruct firefighters and other

workers in the techniques of maintaining and donning self-contained breathing apparatus. These

tapes featured the latest findings from the testing

of these devices.

Planning

In 1977, NIOSH conducted a nationwide survey of governmental agencies and nonagricultural

firms with more than 100 workers to determine

the current number of employed occupational

safety and health professionals and to predict

future demand. Based on nearly 3,300 survey responses, NIOSH estimated the number of full-time

professionals to be between 104,360 and 110,840

and forecast 3,100 new positions a year would be

available by 1990. Growth in demand was concentrated in jobs that “inspect, interpret, investigate, and plan, ” such as industrial hygienists

and safety engineers (570).

The future supply of occupational safety and

health personnel was estimated in another NIOSH

survey by asking 112 programs in occupational

safety and health education how many graduates

they expected in the future. These results, combined with estimated numbers of personnel

trained by insurance companies and by the Federal Government, showed that in 1977 the demand exceeded supply of occupational safety

specialists, occupational health nurses, and occupational health physicians, but that the demand

equalled supply for industrial hygienists. Due to

survey limitations, data collected at that time were

insufficient to predict adequacy of supply of occupational safety and health personnel by 1990

(570). A report that updates work force supply

and demand information has been completed

(584); however, publication of the report awaits

OMB approval.

The NIOSH surveys of demand and supply,

like all such projections into the future, were based

on assumptions about conditions in the years

ahead. Because of the sagging economy in the

early 1980s, and probably also because of a reduced Federal presence in occupational safety and

health, there have been few positions available

in this field. The Advisory Panel to this assessment lamented the fact that occupational safety

and health professionals are often among the first

Photo credit E.I. du Pont de Nemours & Co

Measuring the concentration of potentially harmful

gases is one aspect of an industrial hygienist’s job
198 ● Preventing Illness and Injury in the Workplace

to be laid off from company and union jobs, but

could offer no suggestions to alter that condition.

Training Grants

NIOSH’s findings of shortages of trained occupational safety and health graduates were cited

in successful efforts to expand training grants programs. One part of this expansion was to introduce the concept of multidisaplinary educational

resource centers. The other part was growth of

single-discipline training grants.

Single-discipline training project grants have

been established in 28 universities, and over 100

different academic degree programs were in place

in 1980. Because of budget cutbacks, the number

of programs was reduced to 60 in 1982. The number of professionals graduating from these and

ERC programs each year increased from 217 in

1976 to 747 in 1980. As shown in figure 10-1, the

number of graduates increased as the funding increased.

Educational Resource Centers

Congress authorized creation of up to 20 Educational Resource Centers for occupational safety

and health in 1976. Funding increased from $2.9

million in 1977 to $12.9 million in 1980, and the

ERCs now number 15. These centers: 1) provide

continuing education to occupational health and

safety professionals; 2) combine medical, industrial hygiene, safety, and nursing training so that

graduates are better able to work effectively in

complex and diverse conditions; 3) conduct research; and 4) conduct regional consultation services. All ERCs but one are located in universities.

The centers are distributed as far as possible to

give regional representation and to meet training

needs for all areas of the Nation. The Federal cost

of ERC education is approximately $7,000 for

each degree graduate and $70 for each attendee

at continuing education courses (102).

Recent budget cuts have reduced the current

level of funding for Educational Resource Centers

to $5.8 million, 55 per cent below the level in fiscal

year 1980. According to projections by the Association of University Programs for Occupational

Health and Safety, if Federal funding for ERCs

had been eliminated as proposed in the President’s

fiscal year 1984 budget, the number of graduates

completing their programs would have decreased

to approximately 338 (compared with about 781

in 1981) and only about 25 degree programs of

the 112 programs currently in existence could have

been expected to survive. Furthermore, there was

concern that without Federal funds, multidisciplinary programs would revert to more narrow

and limited single-discipline programs.

While the President’s 1984 budget for NIOSH

contained no request for ERC funding, the Congress added $8.8 million for the centers.

Other Training Programs for

OSH Professionals

Other Federal agencies and private companies

train occupational safety and health professionals

in special cases. OSHA maintains a training institute in Des Plaines, IL, primarily to give shortterm training to State and Federal compliance officers, and the institute also provides short courses

to some private sector groups (636). The Mine

Safety and Health Administration maintains a

Training Academy in Beckley, WV, to give shortterm training to its inspectors (452).

Many short-term training courses for workers

and occupational safety and health professionals

are sponsored in the private sector. The courses,

including a wide variety of specialized short-term

training in both illness and injury prevention, are

announced weekly in journals such as the Occupational Safety and Health Reporter published by

the Bureau of National Affairs. The number of

private sector courses has grown substantially

since the passage of the OSH Act.
Ch. 10—Training and Education for Preventing Work-Related Injury and illness ● 199

ENGINEERS AND MANAGERS

Although there appears to be a growing awareness in the business community of the costs of

work-related illness and injury (284), little information is provided about prevention in business

schools (579). Furthermore, there is little evidence

that engineering schools treat the subject at any

level, but there are some attempts to change this.

Professional engineering societies and trade associations have formed committees on occupational

safety and health, governmental agencies are conducting training and information programs, and

educators are slowly becoming concerned.

Engineers and business managers are often unaware of the potential for reducing work-related

injuries and illnesses either because the hazard remains to be identified or because information

about it is new and inadequately disseminated.

Even after a hazard is recognized, these business

decisionmakers may lack access to information

on which to base plans for prevention.

Educating Engineers

The engineering curriculum is one of the few

that prepares baccalaureate degree holders for a

professional license. Because it provides both an

undergraduate and a professional education, the

curriculum is a crowded one and under constant

pressure to add new material. Occupational safety

and health would be a useful addition or augmentation to currently scheduled lectures, but it is difficult to squeeze it in.

Few people more fully recognize the difficulties

of the engineering curriculum than professional

educators, yet they see some opportunities to increase safety and health instruction. For instance,

industrial-hygiene-engineering educators recommend, in a recent report, presenting students with

information on recognition and control of workrelated injury and illness hazards and making such

information available to practicing engineers

(587). They single out design engineers as a particularly important group because the greatest opportunity for change is in the planning stages of

industrial processes. “All undergraduate engineering curricula (particularly design courses) should

include instruction on the responsibilities of engineers for occupational safety and health engineering problems and solutions” (587). The report also

recommends that academic programs in occupational safety and health should be offered to practicing engineers as continuing education. The American Board of Engineering and Technology, which

accredits programs in engineering, finds it “desirable” for engineering schools to teach safety (4).

Specific legal responsibilities require professional engineers to protect workers and the public as well as their employers. Professional engineers may be required to act according to the

prevailing practice of the profession by State law,

but they may lack knowledge about local or Federal regulations or penalties for noncompliance.

Indeed, engineers have been held accountable for

the actions of untrained subordinates in some

cases. In the case of workplace health and safety

regulations, training may be absent since few

schools of engineering have courses bearing on

responsibilities under the Occupational Safety and

Health Act.

Complicating problems for engineering schools

are current pressures to update curricula to meet

rapidly changing technology, to respond to the

sudden upsurge in enrollment, and to upgrade

faculty and overcome critical staff shortages.

Undergraduate enrollment exceeded 387,500 in the

academic year 1981-82. This was an all-time high

for the Nation’s 286 engineering schools (419).

Training Business Managers

According to a national survey of 217 schools

of business management accredited by the American Assembly of Collegiate Schools of Business
200 ● Preventing Illness and Injury In the Workplace

(a group representing a majority of business management schools) that was conducted by the National Safety Management Society, few specify

safety management studies as a degree requirement (311). It is not difficult to imagine that such

studies would be of low priority in management

schools, but some companies argue that commitment of top management is the single most necessary ingredient in safety and health programs

(156).

ing programs in business schools. The project will

be publicized through a series of briefings given

to administrators and faculty at selected business

schools. Audiovisual materials will be prepared

and a case-study book assembled containing 50

related occupational safety and health articles.

These materials will be designed so that they can

be used in classwork by the business educators

(584).

NIOSH and OSHA have begun Project Minerva

to develop occupational safety and health trainCOMPUTER NETWORKS AS AN EDUCATIONAL TOOL

Improving the quality and quantity of information available about preventing work-related

injury and illness depends upon finding solutions

and communicating the solutions to people who

will benefit from them. The traditional methods

of information exchange are journal articles, presentations at professional meetings, and various

kinds of consultation. Computer conferences—

formed by people who share common interests

and who “participate” in the conference by sending and receiving messages in a central computer—are an experimental method of information

exchange. They have been tried on a limited scale

for the exchange of information about occupational safety and health and on a larger scale

within companies to exchange technical information. It is unclear what their eventual value will

be, but they have been praised by some occupational safety and health professionals who have

used them.

NIOSH Use of Computer Networks

One of the duties of the Technical Information

Division of NIOSH is to draft responses to

OSHA-proposed rules. NIOSH used computer

conferences to respond to two 1982 Advance Notices of Proposed Rulemaking from OSHA. One

notice concerned “Hazard Communication” (the

“labeling standard”), which details what information is to be provided to workers about the chemicals to which they are exposed. The other dealt

with OSHA’s regulation concerning Access to Employee Medical Records, which stipulates what

medical records are to be retained by employers,

for how long, and who has access to them. In both

cases, NIOSH arranged a conference that involved

about 10 NIOSH employees in scattered locations;

there was little overlap in the membership of the

two groups.

NIOSH participants consider the exchanges to

have been a success. The computer-time cost for

the hazard communication exchange was $2,500,

about two-thirds as much as a 2-day meeting at

NIOSH in Cincinnati, which would be an alternative method of gathering needed responses.

A NIOSH-MIT exchange was organized differently. The Reader’s Digest computer data base,

the Source, has software called PARTICIPATE

that permits its users to join in conferences. Three

professionals with expertise in computers and

video display terminals posted a message on the

Source inviting comments and discussion. Over

a dozen participants joined in; the discussions followed two paths—one concerning possible health

effects from radiation and ergonomic considerations, the other stress and quality of work.

Priest (377) sees the NIOSH-MIT exchange as

a limited success. It attracted participants, but because it did not have a goal, such as producing

a document or answering a question, the exchange

strayed, just as undirected conversations do.
Ch. 10—Training and Education for Preventing Work-Related lnjury and Illness 201

Privacy and Trade Secret Concerns

In the late 1970s, a large United States-based

pharmaceutical firm with over 60,000 employees

worldwide developed its own system of computer

exchanges and over 4,000 employees use it. The

firm’s Vice President for Research and Development considers it a “crucial and integral part” of

the firm’s development and management operations (377).

The system is used extensively by employees

concerned about product safety. Although the

firm’s representatives stated that they used the system considerably for health and safety purposes,

they would not disclose any details about the content or process (377). Concern about disclosing

business secrets was partially responsible for the

company’s not discussing computer exchange of

safety and health information. In addition, a company representative stated that sharing its health

and safety information with other companies

might make the company subject to antitrust actions. Only trade associations and public meetings

were seen as acceptable for sharing information

(377).

The firm in this situation has made an implicit

tradeoff—between, on the one hand, deaths and

injuries that might be reduced by disclosing inSUMMARY

Traditionally, education and training programs

have focused on workers and safety and health

professionals. However, with recognition of the

importance of designers, engineers, and managers

in health and safety, some attention is now given

to providing them with the principles of prevention and control.

Both OSHA and NIOSH are involved in education and training programs. OSHA has supported worker training and education; NIOSH

grants are used primarily for education of occupational health and safety professionals. Both participate in Project Minerva, with the objective of

introducing health and safety into business administration curricula. NIOSH has also sponsored

workshops directed towards adding health and

formation about their methods and, on the other

hand, their proprietary business interests and desire for privacy. There is also the possibility that

the firm was concerned about disclosing information about product safety discussions that might

be “discoverable” in a legal proceeding (377).

The Future of Computer Exchanges

Computer exchanges are attractive because they

provide fast and interactive communication. The

information is “written down” and can be retrieved. However, a company inhibited by desires

to protect its privacy will be reluctant to allow

employees to participate in a medium as rapid,

fluid, and uncontrollable as computer exchange.

The future of government-sponsored and business computer exchanges among occupational

safety and health professionals is likely to increase

as cost savings become more apparent, as hardware becomes more widely available, and as more

people experience and grow accustomed to this

communication medium. Information exchange

in this manner can enhance face-to-face meetings.

There appear to be few advantages of computer

conferences that are peculiar to occupational

safety and health.

safety topics into the curricula of engineering

schools.

OTA sponsored a survey of worker training

programs. Not unexpectedly, the survey found

that company programs, which are the majority

of programs, emphasize fundamentals of safe

working habits and recognition of hazards.

Union, university-based, and Committee for Occupational Safety and Health programs prepare

workers for a more active role in recognition and

control. The company programs are the norm;

the other programs, which would involve transfer of some power from management to labor, are

more controversial and they do not represent the

only way to go beyond the traditional programs.

For instance, General Motors and the United Auto
208 . Preventing Illness and Injury In the Workplace

Workers cooperate in the training of union safety

stewards in General Motors’ training programs.

NIOSH’s 15 Educational Resource Centers, located across the Nation, represent a departure

from disciplinary training for health and safety

professionals. They emphasize interdisciplinary

training of industrial physicians and nurses, industrial hygienists, and safety engineers. Unfortunately no solid evaluation of the programs has

been carried out, but the ERCs are well regarded

by most professionals.

The stability, if not the very existence, of ERCs

is threatened by uncertain Federal funding. For

each of the last four years, the President’s budget has recommended no Fe&al funding. In each

year, Congress restored funding. Nevertheless, the

threat to the ERCs has seen parallel decreases in

the number of graduate degrees awarded.

One of the surest ways to disseminate new information is to graduate new professionals and

send them into the work force. As enrollment in

graduate programs has declined, ERCs have increased attention to continuing education for practicing health and safety specialists. The flexibility

of ERCs in providing both degree and continuing education programs is an argument for their

continuation.

Evaluation of Federal education and training

programs has consisted largely of counting numbers of graduates and hours of instruction. While

those measures provide an indication of how

much education is going on, they provide no details of the impact of the education. Careful

evaluation would aid in making funding decisions.
●

1 1 .

A Short History of Private

and Public Activities
Page

Voluntary Efforts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205

National Safety Council . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205

American Occupational Medical Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205

American National Standards Institute. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206

American Conference of Governmental Industrial Hygienists . . . . . . . . . . . . . . 206

Governmental Efforts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207

Workers’ Compensation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207

Progressive Era Aims.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207

State Health and Safety Programs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209

Early Federal Government Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210

Federal Research and Assistance in Occupational Safety and Health. . . . . . . . 211

Federal Legislation and Regulatory Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212
11 m

A Short History

and Public

of Private

Activities

Accompanying new methods of factory production in the 18th and 19th centuries were exposures to new working conditions and new hazards. As some associations between hazards and

injuries or illnesses were recognized, efforts were

made to improve working conditions and to reduce or eliminate job hazards. Some of these

VOLUNTARY EFFORTS

The importance of workplace safety was recognized by some large American firms around the

turn of the century in the face of a rising number

of injuries associated with the installation of new

industrial machinery. One positive response was

the creation of employer policies and practices

directed at reducing the frequency of those injuries

(box L). In addition to company-specific efforts,

several voluntary organizations have been created

to promote occupational health and safety.

National Safety Council

The first national organization devoted entirely

to occupational safety, the National Safety Council (NSC), was established in 1912 as a response

to the high industrial accident rate. It popularized

the “Safety First” slogan that had been used by

U.S. Steel. The council was governed by a business-dominated Board of Directors. It sought to

achieve industry consensus for its recommendations, and favored nonmandatory standards,

training and education, and voluntary safety programs (361) as the best method of improving safety records. The NSC thus epitomizes the voluntary safety movement.

Although the council has now shifted its emphasis to automobile and home accidents, its safety publications (and particularly Accident Facts

(324)) are well known and widely disseminated.

originated in the private sector; others, in the

Government. Many of these efforts concerning

occupational conditions were intertwined with attempts to improve public health more generally.

A number of programs were successful, resulting

in improved working conditions, although progress has often been strikingly slow (see, e.g., 218).

The council has worked extensively with the Department of Labor to provide safety training

courses and materials to industry. Industrial firms

that belong to the NSC have been reported to

have “injury rates well below those of non-members” (249). The cause-and-effect relationship between low injury rates and membership in the

NSC is not clear. It is at least as likely that companies with low rates join the NSC as it is that

membership in the NSC results in lower injury

rates.

American Occupational

Medical Association

Industrial medicine originated in large companies that employed surgeons to treat traumatic injuries. By 1915, enough physicians and surgeons

were engaged in industrial health to lead to the

organization of the American Association of Industrial Physicians and Surgeons. Seventy-two

physicians attended the association’s first meeting

in 1916. (In 1951, the association’s name changed

to Industrial Medical Association and later to

American Occupational Medical Association. )

Also in 1915, the American Medical Association

held its first symposium devoted to industrial hygiene and medicine. The American Occupational

Medical Association publishes a monthly journal,

the Journal of Occupational Medicine.

205
206 . Preventing Illness and Injury in the Workplace

rected at technical specifications for manufacturing, such as having common thread pitches for

screws, nuts, and bolts, some of the standards

issued by ANSI are directed at improving occupational safety (249).

The membership of ANSI consists of companies

(company members) and trade associations, government agencies, and private groups (member

bodies). Several unions are also member bodies

of the organization. The “consensus” method used

by the institute is defined in its constitution as a

position “achieved according to the judgment of

a duly appointed authority. Consensus implies

much more than the concept of a simple majority

but not necessarily unanimity.”

ANSI standards are developed by standards

committees and are reviewed, since 1969, by a

Board of Standards Review. The 15-person board

has 9 industry members, 2 representatives from

the Federal Government, 1 from municipal government, 2 academic representatives, and 1 member from a consumer organization. The board is

authorized to decide when a standards committee has reached consensus; this decision includes

counting and weighting the votes of the committee’s members (249). The votes and weighting factors are not made public, although ANSI does circulate drafts to interested parties for comment

throughout the final consensus process. (The

ANSI standards concerning occupational health

and safety that existed in early 1971 were adopted

as regulations by the Occupational Safety and

Health Administration (OSHA) using the authority granted in sec. 6(a) of the Occupational Safety

and Health Act of 1970. See below and ch. 12. )

American Conference of

Governmental Industrial Hygienists

The American Council of Governmental Industrial Hygienists (ACGIH) was founded in 1938 by

a group of industrial hygienists from various levels

of government. The ACGIH is a professional organization that issues “recommendations” that are

developed by a straight membership vote.

By 1968, ACGIH had adopted nearly 400

Threshold Limit Values (TLVs) for hazardous substances. The TLVs are 8-hour time-weighted aver-
. . .

Ch. 11—A Short History of Private and Public Activities ● 207

age values that are suggested limits for workday

exposure; they are “guides for the control of health

hazards” and were historically directed to the toxic

rather than the carcinogenic, cytogenic, or mutagenic properties of chemical substances. In a

special appendix to the 1968 publication, ACGIH

recommended no exposure to a list of carcinogens.

ACGIH standards have been adopted by several

foreign governments and were incorporated in

GOVERNMENTAL EFFORTS

Workers’ Compensation

The first workers’ compensation program was

established in Germany by Otto von Bismarck in

1884, and other European countries soon adopted

their own programs (279), In the United States,

the most important early-20th-century activity of

State governments concerning occupational health

and safety was the creation of workers’ compensation programs. A limited program was established for Federal workers in 1908, and a number of States established commissions to study

possible programs at about that time. Interest in

workers’ compensation derived from several

sources.

The focus of these efforts was on the perceived

deficiencies of the U.S. legal system concerning

compensation for industrial injuries, Under

Anglo-American common law, individuals can

sue others for damages if a wrong has been committed that causes harm. The basic duty of employers was to act with due care for employee

safety, as a reasonably prudent person would, and

to furnish a sufficient number of safe tools and

equipment, as well as a sufficient number of qualified employees to do the work. Employers were

responsible for issuing and enforcing rules for

workplace safety, rules that with ordinary care

would prevent reasonably foreseeable accidents.

Finally, there was a duty to warn workers of unusual hazards.

In theory, if the employer failed to live up to

this standard of conduct, an injured employee

could sue for damages under the common law.

This was not always easy, however. The first difficulty was simply proving the employee’s case.

1969 by the Bureau of Labor Standards of the U.S.

Department of Labor using the authority of the

Walsh-Healey Act (described below). Following

its establishment in 1971, OSHA adopted the

Walsh-Healey standards as its own, resulting in

the TLVs published in 1968 by ACGIH becoming occupational health standards for all U.S. industry (249) (see also ch. 12).

Other employees might be crucial witnesses, but

in the 19th century, when there were few governmental or union job protections, anyone who testified against an employer would risk being fired.

More importantly, the law also established three

powerful defenses that employers could use

against lawsuits brought by employees. These

were:

●

●

●

negligence of other servants or co-workers,

knowledgeable assumption of risk by the employee, and

contributory negligence by the injured

worker.

Progressive Era Aims

In the early 1900s a number of Progressive Era

humanitarian efforts underlined the plight of the

injured worker and paved the way for workers’

compensation programs. Crystal Eastman conducted the now-famous “Pittsburgh Survey” of

1907-08. She examined the economic conditions

of the families of workers who had been killed

or injured. In over half the cases, she found that

“the employers assumed absolutely no share of

the inevitable income loss. ” The costs of work accidents fell “directly, almost wholly, and in likelihood finally, upon the injured workmen and

their dependents. ” She concluded that a system

of compensation was necessary to achieve equity,

social expediency, and prevention (274).

At about the same time, a State commission in

Illinois reported that most court awards for industrial accidents were small, and that the families of the injured were often forced to live on

charity. Moreover, for employers who had lia-
208 Preventing illness and Injury in the Workplace

bility insurance, only 42 percent of payments went

to medical care. The remaining 58 percent went

for administration, claims investigation, and legal

expenses (100).

Employer< Attitudes

The apparently small awards made to most

workers was not the only reason for dissatisfaction with legal remedies. Employers, who as a

group supported workers’ compensation legislation before labor unions did, also found advantages in compensation programs. There is some

evidence that just prior to the creation of workers’ compensation laws, injured workers, at least

in some circumstances, won a substantial portion

of lawsuits against their employers (100,130,234,

316).

Moreover, workers’ compensation substituted

a regular, fixed, and predictable compensation

payment for uncertain, potentially ruinous liability judgments (274). Employers also feared that

without a workers’ compensation system, the

courts would start making more awards to injured

employees, especially if a worker could show that

his/her employer had violated one of the increasing number of State safety regulations (249).

Finally, employers advocated workers’ compensation in order to remove one source of hostility

from labor-management relations and possibly to

prevent more fundamental changes in the workeremployer relationship. They specifically opposed

the passage of liability law reforms that would

have eliminated the common law defenses of employers. Some large companies had already established company benefit plans that provided payments for work injuries. Smaller manufacturers

favored creation of such plans, but lacked the resources to do so privately (667). Larger manufacturers feared that if such plans were not created,

legislators might act to change employer and employee rights. In the absence of changes, it was

feared that the nascent unions would be given a

boost (100,667).

For these reasons, some of the initial advocates

of workers’ compensation included groups like the

National Association of Manufacturers, the National Civic Federation, the American Association for Labor Legislation, and a number of the

leading industrialists of the day.

Labor Union Reactions

Unions, on the other hand, initially opposed

workers’ compensation. They generally wanted

workers to retain the right to sue employers and

advocated abolition of the three common law defenses. They held this position in part because they

thought injured workers would receive larger payments under such a plan and because, at the time,

they generally mistrusted the government and

feared that governmental intervention would

weaken unions (667).

Union opposition was also based on their perception that workers’ compensation was “palliative and not preventive” (279). The belief that

workers’ compensation could provide an economic incentive for prevention was, according to MacLaury (279), important in changing labor’s position; it “seemed to tip the scales. ”

initial Legislation

The very first compensation acts, in Maryland,

Montana, and New York, were ruled unconstitutional. The Federal Government enacted a law in

1908, which covered only certain Federal employees. The first State law to become effective and

remain so was passed in Wisconsin in 1911. Following this breakthrough and aided by the combined support of reformers, business, and labor,

laws were passed rapidly. Four other States passed

laws in 1911. By 1925,24 jurisdictions had enacted

compensation, although it wasn’t until 1948 that

all the States had such laws (249,316,667).

In some cases, workers’ compensation was set

up to supplement rather than to replace the legal

liability system. Lubove states that “[w]here labor had a major voice in shaping compensation

legislation, as in Arizona, injured workers were

allowed a choice of remedy after injury.” It appears that until that choice was removed under

business pressure a decade later, most injured

workers chose the liability route (274).
Ch. II—A Short History of Private and Public Activities ● 2 0 9

Extent of Coverage

The initial laws covered only accidental injuries.

Some state legislatures had no intention of compensating occupational diseases and specifically

excluded them from coverage. Three reasons for

this have been suggested. First, workers’ compensation laws were created to supplant common law

liability. Under the common law, workers were

consistently denied recovery for occupational diseases. Second, it was thought that compensation

for disease would be so expensive that it would

best be handled under a general health or disability insurance program. For example, it was

believed that complete coverage of certain occupational diseases, such as silicosis in foundries,

mines, or quarries, would be extremely expensive

for the compensation system and those particular industries (261).

It has also been suggested that some of the writers of the early workers’ compensation laws used

language that would not alarm legislators, but

would be flexible enough to allow the courts to

extend coverage to occupational disease (46).

Massachusetts was the first State to compensate

disease when the courts acted in just this way. But

by 1928, only 10 States covered diseases. From

1931-39, 14 States added coverage, while 18 States

did so in the 1940s. The 7 remaining States added

coverage between 1951 and 1967 (261). (See ch.

15 for a discussion of the current workers’ compensation system. )

State Health and Safety Programs

Most early occupational health and safety efforts in the United States occurred at the State

level. Occupational safety laws were enacted by

various States during the 19th century. As seems

to be often the case, there appears to have been

a tendency to direct the laws at what were, at the

time, new technologies. For instance, in 1852,

Massachusetts passed a law regulating steam engines and permitting State inspectors the “power

of closure” in situations of grave hazard (249).

Twenty-five years later, in 1877, the same State

passed the first factory-inspection law that required the installation of certain safety devices

(guarding of belts, shafts, and gears), fire exits,

and protection on elevators (279).

The early lead of Massachusetts in establishing regulations about workplace safety was followed elsewhere. By 1890, 22 States had passed

regulations permitting safety inspectors in mines,

and 14 had factory and workshop inspectors.

However, these early laws were rarely enforced,

partly because inspectors, who were often political appointees, were too untrained to recognize

even the most obvious safety hazards.

In the first decades of this century, Alice Hamilton (box M) and other researchers actively pursued the work-relatedness of certain diseases.

Their work was important in stimulating the interest of State governments in occupational

health. By 1913, programs were organized in Connecticut, New York, and Ohio. The first important occupational disease laws, the “lead laws, ”

were passed in New Jersey, Ohio, and Pennsylvania (373).

Despite the establishment of these State occupational health and safety programs in the early part

of this century, these programs were often deficient. A 1964 study reported that, on average,

there was only one occupational health staff member for every 108,000 workers, and there were

fewer than 1,600 safety inspectors in the various

State programs combined (249).

A survey taken in 1968 found that occupational

health programs were in place in only 20 States

and jurisdictions and that most States had more

game wardens than safety inspectors. State occupational safety programs, which were much

more highly developed than occupational health

programs, covered only the mining portion of the

work force in 4 States, and 1 State had no safety

legislation at all until 1967. State expenditures on

occupational safety ranged from 1 cent per employee in Wyoming to $2.70 per worker in Oregon.

In addition, as late as 1969, only 21 States gave

safety inspectors the right to shut down a work

area that presented an imminent hazard (249).

Moreover, even in the States with occupational

health programs, the powers to develop and enforce occupational health laws and to inspect

worksites were often diffused through several

agencies. The resulting fragmentation of powers

contributed to the difficulties of enforcing State

occupational health laws.
210 Preventing Illness and Injury in the Workplace

A final complication of separate State laws is

illustrated by what happened when Pennsylvania

banned the use, manufacture, storage, and handling of beta-naphthylamine, a carcinogen. Soon

after the ban, another facility in another State

began producing the chemical (249). This Stateby-State approach was also criticized by business

representatives. A keynote speaker at a trade association meeting in Washington in 1973 noted:

When . . . [there is] a proliferation of different

state plans and state enforcement . . . American

business [has] great difficulty because most

. . . companies . . . are multiproduct, multiplant

companies. Having to live with . . . 40 or 50 different approaches . . . as distinguished from a

single set of rules . . . concerns me greatly (277a).

Thus, by the time Congress considered Federal

occupational health and safety legislation in the

late 1960s, there was widespread agreement that,

as one historian has summarized it, “safety and

health laws, historically left to the States, were

piecemeal, varied in quality, and often unenforced” (124).

Early Federal Government Programs

As early as 1790, the First Congress appeared

to take an interest in the safety of merchant seamen by giving the crew of a ship at sea the right

to order the vessel into the nearest port if a majority of the seamen plus the first mate believed

it unseaworthy (279). In 1798, the Marine Hospital Service, which evolved into the Public Health

Service, was established to provide care to seamen

disabled on the job. The Hospital was paid for

through the first system of health insurance in this

country: a tax of 20 cents annually deducted from

all seamen’s wages (249). In the early 19th century, the Marine Hospital’s physicians were primarily concerned with the control of epidemic diseases, such as cholera and yellow fever, which was

more in the realm of public health than worker

health.

Federal employees benefited from several measures passed in the 1800s: an 1833 law granted

compensation to disabled seamen; an 1868 law

limited the workday of Federal employees to 8

hours; in 1908 and 1916, workers’ compensation
Ch. 11—A Short History of Private and Public Activities . 211

was enacted for Federal railroad and other employees. Several early attempts (1796, 1852) at

Federal intervention in matters of public health

(such as enforcement of maritime quarantine and

State grants to establish asylums for the insane)

were rebuffed by the States, which considered

public health their responsibility (249).

Federal Research and Assistance

in Occupational Safety and Health

The Public Health Service (PHS) activities were

extended to the workplace in 1914 when the Office of Industrial Hygiene and Sanitation was established in the Division of Scientific Research

(249). During the next 20 years, the office engaged

in research to identify occupational health hazards

and their effects. It studied lead poisoning, looked

at hazards in brass foundries and in the glass and

chemical industries, and made sanitary surveys

in war plants during World War I. It also conducted studies about the physiological effects of

lighting, high temperature, fatigue, and other environmental conditions in the workplace.

A study in 1924 followed up the deaths of 20

people who had been employed in the painting

of radium watch dials. Recommended control

measures subsequently ended radium poisoning

in the watch industry. Less spectacular, but bearing on the health of many more workers, was the

Office of Industrial Hygiene and Sanitation’s

study of the dusty trades. Begun in 1923, this research showed the extent of health impairment associated with the granite, pottery, cement, cotton textile, and mining industries.

During this same early-20th-century period, the

U.S. Bureau of Labor, and its successor, the Department of Labor, also sponsored research on occupational health and safety. Its reports included

studies of lead poisoning, phosphorus-caused disease, the dusty trades, and industrial accidents

(124). A 1910 report on “phossy jaw,” published

by the Bureau, was important in revealing the nature of that occupational health problem. In the

second decade of this century, the Bureau employed Alice Hamilton to investigate occupational

hazards especially in the “dusty trades” and published the results of her studies (279).

The passage of the Social Security Act in 1935

led to an expansion of PHS studies of occupational

hazards and to the provision of grants to States

for public health work, including industrial hygiene activities. During the 1930s, the Public

Health Service studied the health effects of lead

in gasoline and of fumes of chromic acid and mercury in the workplace.

A 1937 reorganization of the PHS resulted in

the Scientific Research Division being consolidated with the National Institutes of Health (249).

The Office of Industrial Hygiene and Sanitation

along with the Office of Dermatoses Investigations

became the Division of Industrial Hygiene of the

National Institutes of Health. Seven years later,

because of the marked increase in its work with

States, the Division was transferred to the Bureau

of State Services.

In World War II, as in World War I, the PHS

was concerned with the protection of employee

health in government-owned, privately operated

munitions plants. A dramatic illustration of the

success of these efforts is provided by mortality

associated with TNT manufacture in both wars.

During 7 months of World War I, 475 workers

died and 17,000 were disabled by fumes; in World

War II, there were 22 deaths in 35 months. In addition, studies were carried out in aviation medicine and on the health effects of new chemicals

and metals, such as vanadium and beryllium,

newly introduced into airplane manufacture.

Other reorganizations followed World War II.

In 1953, the Federal Security Agency, which had

included the Public Health Service, was abolished,

and the Department of Health, Education, and

Welfare (HEW) was established. The Division of

Industrial Hygiene became the Occupational

Health Program and remained in the Bureau of

State Services until it was designated the Occupational Health Program in the Bureau of Disease

Prevention and Control in 1966. Other organizational moves within the Department followed,

and it was renamed the Bureau of Occupational

Safety and Health (249).

The Occupational Safety and Health Act in

1970 established the National Institute of Occupational Safety and Health (NIOSH), and in 1973
212 Preventing Illness and Injury in the Workplace

NIOSH was transferred to the Centers for Disease Control of the PHS. During all the bureaucratic reorganizations since it began in the Public Health Service, the occupational health

program has produced important studies about

occupational health and, more recently, safety.

Federal Legislation and

Regulatory Programs

Federal regulatory attention has historically

focused on several high-hazard industries, such

as mining, longshoring, railroading, and construction. The coal mining industry provides an example of Federal efforts to control occupational

hazards in these industries.

Coal Mine Safety Legislation

In the wake of the Monongah, WV, coal mine

disaster of 1907 that killed 362 miners and other

accidents that caused the loss of many lives, the

Bureau of Mines was established in 1910 within

the Department of Interior to promote mine safety. Bureau personnel were specifically denied “any

right or authority in connection with the inspection or supervision of mines.” Although the powerlessness of Bureau personnel was widely deplored, it was not until 1941 that the Federal Coal

Mine Health and Safety Act, which granted inspection authority to the Bureau, was passed. An

excerpt from the House of Representatives report

accompanying the bill captures the sense of Congress at the time:

Investigation reveals no common standard of

safety among the States, no common regulations,

and, in addition to this, a lack of uniform enforcement of such [State] regulations as are in effect

. . . . In order to supplement the work of the

State agencies, the bill under consideration extends and enlarges the authority of the Federal Bureau of Mines. It is not regulatory in any sense.

It merely authorizes the Bureau, through its representatives, to make inspections of the underground workings and publicize its findings and

recommendations. These inspections , . . are to

be made in conjunction with the local State agencies so that there is no assumption of the State

authority (quoted in 249).

Later laws gradually increased Federal authority over coal mine hazards; in 1966, Bureau inspectors were permitted to close certain establishments operated by employers guilty of repeated

serious violations.

A disastrous explosion in 1968 killed 78 miners

in Farmington, WV. This crystallized public attention on mine safety. Citing the Federal Government’s “fatalistic attitude” and failure . . . “to

act vigorously to change [the prevailing bad practices], ” the 91st Congress passed the Coal Mine

Health and Safety Act of 1969 (the Coal Act)

(249).

Despite the increase in authority given to the

Federal Government by the 1969 Coal Act, safety

and health conditions in the mines continued to

be unacceptable to the Congress; in 1973, approximately one of every 1,500 miners, compared with

one of every 12,400 workers in general industry,

were reported to have been killed. In 1977, Congress passed the Federal Mine Safety and Health

Amendments Act, the first Federal law to consolidate jurisdiction over both coal and metal mines

and all safety and health matters (except training

and research) in one executive department. The

Department of Labor was empowered by this Act

to inspect mines, and to develop, promulgate, and

enforce safety and health standards applicable to

mines (249).

Legislation for Other Industries

The New Deal. —Frances Perkins, selected by

President Franklin D. Roosevelt in 1983 to be the

Secretary of Labor, brought experience in occupational safety and health to that position. In

1934, she created within the Department the Bureau of Labor Standards, the first permanent Federal agency with a mandate to promote safety and

health for the entire work force. To a major extent, the Bureau acted by aiding the States in the

administration of their workplace health and safety laws and by promoting protective legislation.

Three New Deal-era laws contributed to a

growing Federal involvement in occupational safety and health. As noted above, the Social Security Act of 1935 provided for the Public Health

Service’s funding of State industrial health programs. In addition, the Fair Labor Standards Act

of 1938 (the “minimum wage law”) allowed the

Labor Department to bar employment of persons
Ch. 17—A Short History of Private and Public Activities 213

.

under 18 in dangerous jobs, while the WalshHealey Public Contracts Act of 1936 directed the

Department to ensure standards for safe work by

Federal Government contractors and to “blacklist”

contractors who did not comply with the standards (279). This last act is of particular interest

because it created a Federal regulatory role concerning job safety and health and located this

function in the Department of Labor.

Walsh-Healey Act.–This legislation covered all

employees working for employers who had contracts with the Federal Government that exceeded

$10,000 in total value. The McNamara-O’Hara

Act of 1966 and the Construction Safety Act of

1969 extended Federal regulation to service contract employers and Federally funded construction employers, respectively. Employers were required by the terms of their contracts to comply

with Walsh-Healey safety and health standards,

which were recommended by the Bureau of Labor Standards of the Department of Labor. The

Bureau of Labor Standards was also given the authority to inspect workplaces covered by the

Walsh-Healey Act and had the power to prohibit

employers who violated the act from bidding on

Federal contracts for a period of three years.

Federal involvement in setting safety and health

standards intensified in the late 1950s. In 1958,

an amendment to the Longshoremen’s and Harbor Workers’ Compensation Act extended the

Federal role in protecting safety and health in the

hazardous maritime trades. The amendment authorized the Labor Department to set standards

in those trades and to seek penalties against employers who willfully violated safety and health

standards, Compliance with the standards was

good after enforcement began in 1960, and accident rates in the maritime trades declined (279).

Acting on its own in December 1960, the Labor Department issued a set of mandatory safety

and health standards under the Walsh-Healey Act.

However, objections were raised to the rigidity

of the rules that the Federal Government required

State occupational safety agencies to enforce when

they inspected Federal-contract workplaces. The

criticisms were heeded by the Department, and

hearings about the Federal standards were held

in March 1964.

The Federal Bureau of Labor Standards almost

never used its inspection and enforcement powers;

in 1969, only 5 percent of the 75,000 firms covered by Walsh-Healey were inspected. At the

3,750 worksites inspected by the Bureau in 1969,

a total of 33,000 violations of safety regulations

were recorded, while only 34 formal complaints

were issued. Two companies were blacklisted

(prohibited from bidding on Federal contracts) in

1969, and three had been similarly treated in 1968

(361).

The history of events under the Walsh-Healey

and other acts exemplifies the sporadic efforts of

the Federal Government to control occupational

hazards in the years before OSHA. However, a

pattern of increasing Federal involvement, such

as the progression that occurred in mining, can

be seen, particularly in the extra-hazardous

trades—maritime, railroading, and construction.

In each case, the first laws permitted Federal personnel to inspect specific aspects of hazardous

operations, such as man-cages (personnel hoists)

in mines, air brakes on trains, and shackles and

other rigging components in longshoring. This

first stage was gradually followed by Federal

assumption of the responsibility for developing

or recommending standards, helping employers

to comply with them (and only rarely, in cases

of grave danger, using the power of closure), and

finally enforcing them. In all cases, the creation

of Federal agencies with inspection and enforcement authorities required more than a half-century from the time of initial congressional action

(249).

The Occupational Safety and Health Act of

1970.—One result of the strong criticisms voiced

before and during the 1964 Department of Labor

hearings was a decision of the Department to examine its safety and health policy. A study by an

independent consultant characterized the Labor

Department’s safety laws and programs as fragmented (279). During this period of self-examination, the environmental movement was attracting

public and congressional support in its bids for

Federal laws to protect human health and the environment from the effects of pollution. The environmental movement spilled over into questions

of occupational health because of the attention
214 . Preventing Illness and Injury in the Workplace

paid to chemicals as risks to health and the reasonable extension of “environment” to include the

workplace.

The Public Health Service published Protecting

the Health of Eighty Million Americans (the “Frye

Report”) in 1965, which drew attention to threats

to health from new technologies. Although it

highlighted the evidence that some chemicals were

associated with cancer causation, it also emphasized that many “old” occupational health problems had not been remedied. The report suggested

an approach to improve occupational health that

would require a major new effort from the PHS.

The AFL-CIO urged President Lyndon Johnson

to respond to the PHS report’s recommendations

(279).

With the President expressing interest in occupational safety and health, both the Labor Department and the Department of Health, Education, and Welfare began development of legislation for a Federal program in occupational safety

and health. The departments deadlocked on the

issue of which one would control the national program in late 1966, and the effort stalled (279).

A dramatic bureaucratic action led the Bureau

of the Budget to accept the Department of Labor’s

recommendations for legislation rather than those

of HEW. In 1967, it was learned that abnormally

high numbers of uranium miners were dying of

lung cancer. Later that year, the Federal Radiation Council, composed of representatives from

a number of Federal agencies, met to consider protective measures for uranium miners. They came

to an impasse concerning the standard proposed

by the Atomic Energy Commission versus the

more stringent standard proposed by the Department of Labor. Unhappy with their indecision,

Secretary of Labor Willard Wirtz adopted the proposed Department of Labor standards under the

provisions of the Walsh-Healey Act the very next

day. This bold move was instrumental, according to MacLaury (279), in the Bureau of the Budget accepting the Department of Labor’s recommendations about legislation.

In January 1968, President Lyndon Johnson

called on Congress to pass job safety and health

legislation closely modeled on the recommendations of the Department of Labor. The proposal

gave the Secretary of Labor the responsibility of

setting and enforcing standards to protect 50 million workers. The bill also had a general duty

clause requiring employers to “furnish employment and a place of employment which are safe

and healthful. ” It gave inspectors legal authority

to enter workplaces without management’s permission or prior notice. Violators could be punished with civil or criminal penalties. Interested

states could develop their own occupational health

and safety programs to replace the Federal one.

The Department of HEW would provide the Labor Department with scientific information (279).

Although hearings were held, that bill did not

reach the floor of either the House or the Senate.

Part of the reason was the opposition of business,

particularly the Chamber of Commerce, to bestowing so much power on the Secretary of Labor and to undermining the role of the States in

occupational safety and health. Also important

were other events of 1968: Riots in the inner cities, protests against the war in Vietnam, and President Johnson’s decision not to run for re-election

competed with occupational safety and health for

public and congressional attention.

In 1969, Congress passed the Coal Act (see

above) and President Richard Nixon introduced

a new version of an occupational safety and health

law for all U.S. workers. His version skirted the

issue of whether the Department of Labor or HEW

was to have the lead in the Federal program. The

duty of Labor was to inspect workplaces for compliance with standards. The role of HEW was to

carry out research. The important function of issuing safety and health standards would be vested

in an independent, five-person standards-setting

board. The Nixon proposal also stressed the use

of existing State government programs and private industry efforts (279).

Objections to the Nixon bill were raised by

many Democratic and some Republican congressmen. Their concerns involved the independent

standards-setting board, because of the administrative confusion it would cause and its lack of

political accountability. Labor unions, in particular, opposed this board, preferring instead that

the authority to set standards be given to the Secretary of Labor. In addition, objections were
Ch. 11—A Short History of Private and Public Activities ● 215

raised to the bill’s enforcement scheme because

it would penalize only willful, flagrant violators.

Finally, the bill’s reliance on industry-written

“consensus” standards, exemptions for small employers, and a three-year delay in its effective date

were also points of criticism (279).

In response, Democrats in the House and Senate had already introduced their own bills and

both the House and Senate committees reported

to the floor bills sponsored by Democratic members. In the Senate, Peter Dominick (R-CO) presented a substitute bill that would have established

two independent boards—one to issue standards

and one to decide enforcement appeals. This was

rejected by a two-vote margin. Then Jacob Javits

(R-NY) introduced an amendment that gave the

Secretary of Labor the authority to set safety and

health standards and established a separate commission to oversee Department of Labor enforcement of the standards. This amendment was

adopted, although another amendment to restrict

the authority of inspectors to close down hazardous operations was narrowly rejected. (In addition, there was some debate on the criteria for

standards. This is discussed in ch. 14).

In the House, Congressman Steiger (R-WI) proposed as a substitute an amendment that represented a modification of the original Nixon proposal and this substitute was adopted. The

conference committee had to resolve a large number of differences. They used the framework of

the mom liberal Senate bill. The single most important change from the Senate version was the

deletion of a provision that allowed the Secretary

of Labor to close down a plant under conditions

of “imminent danger. ” Under the provisions of

the bill that emerged from conference, the Secretary is required to obtain a court order before closing a plant that poses an imminent danger. President Nixon, through the Secretary of Labor, let

it be known that he approved the bill, and both

the House and Senate passed the Occupational

Safety and Health Act of 1970 (279).
.-

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Governmental Activities

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“. Current Federal/State Framework . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219

Separation of Research and Regulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220

Federal Spending for Occupational Health and Safety . . . . . . . . . . . . . . . . . . . . 221

Assistant Secretaries and Directors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221

, --r +. The Occupational Health and Safety Administration . . . . . . . . . . . . . . . . . . . . . . . 224

., . OSHAStandard*setting..•• ● ● . . . ● . . . . . ● ● . . ● ● . . . . . . . . ● . . . . . . . . ● . . . . . . . . 224

Enforcement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232

Public Education and Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237

, State programs and Other Federal Agency Activities . . . . . . . . . . . . . . . . . . . . . 239

. The National Institute for Occupational Safety and Health . . . . . . . . . . . . . . . . . . 242

Identification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243

Development of Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . $ . . . . . . . . . . . . . . . . . 247

Dissemination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249

NIOSH Priorities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253

Table

12-1.

12-2.

12-3.

12-4.

12-5.

12-6.

12-7.

128.

12-9.

Figure

12-1.

12-2.

12-3.

12-4.

12-5.

LIST OF TABLES

No. Page

Federal Spending for Worker Health and Safety . . . . . . . . . . . . . . . . . . . . . . 222

OSHA Assistant Secretaries and NIOSH Directors . . . . . . . . . . . . . . . . . . . . 223

OSHA Health Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228

OSHA Safety Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229

Federal OSHA Safety and Health Inspections. . . . . . . . . . . . . . . . . . . . . . . . . 232

OSHA Onsite Consultation Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238

State Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240

NIOSH Budget for Control Technology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 248

Control Technology Assessments Performed by NIOSH in

Fiscal Year 1982 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 248

LIST OF FIGURES

No. Page

OSHA Budget 1971-85 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223

NIOSH Budget 1971-85 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223

Percent Change in Appropriations for Selected Health-Related Agencies

1980-84 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223

Occupational Safety and Health Administration . . . . . . . . . . . . . . . . . . . . . . 225

National Institute for Occupational Safety and Health . . . . . . . . . . . . . . . . . 243
— —

12

Governmental Activities Concerning

Worker Health and Safety

This chapter has three major sections. The first vialing public education and services, and monidescribes the framework of U.S. Government ac- toring the performance of State programs. The

tivities created by the Occupational Safety and third section describes the activities of the NaHealth (OSH) Act, while the second discusses the tional Institute for Occupational Safety and

main activities of the Occupational Safety and Health (NIOSH) in hazard identification, research

Health Administration (OSHA): setting stand- on controls, and information dissemination.

ards, inspecting and enforcing regulations, proCURRENT FEDERAL/STATE FRAMEWORK

In the Occupational Safety and Health Act of

1970, Congress authorized the creation of three

agencies to set and enforce mandatory health and

safety standards; to conduct research on occupational hazards and their control; and to review

contested enforcement actions. The three agencies are OSHA, NIOSH, and the Occupational

Safety and Health Review Commission (OSHRC).

One other Federal agency, the Mine Safety and

Health Administration (MSHA) of the U.S. Department of Labor, specializes in worker health

and safety. It is responsible for the health and

safety of workers in coal mines, as well as in other

metal and nonmetal mines. It was created as a result of the Metal and Non-Metallic Mine Safety

Act of 1966, the Coal Mine Health and Safety Act

of 1969, and the Mine Safety and Health Act of

1977 (333). Its activities are not described in detail

in this assessment.

OSHA is a regulatory agency that sets and enforces regulations concerning the control of health

and safety hazards. It began its operations on

April 28, 1971. Part of the Department of Labor,

it is headed by a Presidentially appointed Assistant Secretary of Labor for Occupational Safety

and Health, to whom the Secretary of Labor has

delegated authority to administer the OSH Act.

OSHA sets mandatory health and safety standards, inspects workplaces to ensure compliance,

and proposes penalties and prescribes abatement

plans for employers found violating the standards.

In addition, OSHA provides for public, worker,

and employer education and consultation, mostly

through grant activities. Finally, OSHA partially

finances the operations of State agencies operating “State plans” and monitors their performance.

NIOSH is a research agency that is part of the

Centers for Disease Control (CDC) of the U.S.

Public Health Service, which is part of the Department of Health and Human Services (HHS).

NIOSH is headed by a Director appointed by the

Secretary of HHS for a term of six years. It was

created from what had been the Bureau of Occupational Safety and Health and started operations

as NIOSH on June 30, 1971. Congress mandated

that it conduct research and related activities on

developing criteria or recommendations to be used

by OSHA in setting standards, on identifying and

evaluating workplace hazards, and on measurement techniques and control technologies, as well

as provide professional education and disseminate

health and safety information.

The OSHRC has three members appointed by

the President, with the advice and consent of the

Senate, for staggered terms of six years. Its duties

are limited to reviewing and resolving disputes

concerning OSHA citations and penalties. In doing so, the Review Commission interprets the

219
220 . Preventing Illness and Injury in the Workplace

meaning of OSHA standards and thus determines

the nature and scope of many employer obligations concerning employee health and safety.

In addition, the act created a temporary commission to examine the workers’ compensation

system—the National Commission on State

Workmen’s Compensation Laws. It also created

a permanent advisory body for OSHA, known

as the National Advisory Committee on Occupational Safety and Health.

Both OSHA and NIOSH have been criticized

since their creation in 1971. OSHA has been called

to task by employers and their representatives for

issuing standards that are excessively expensive,

overly stringent, not based on scientific evidence,

or unrelated to employee health and safety. Labor unions, on the other hand, have criticized

OSHA for failing to devote adequate resources

to enforcement, for delaying or failing to set new

regulations, and for considering employers’ costs

as a basis for health and safety decisions.

NIOSH, too, has been accused of having failed

to fulfill its mission. OSHA has complained about

the inadequacy of NIOSH’s criteria documents for

OSHA standard-setting. NIOSH has been criticized by the General Accounting Office for the

quality of its criteria document and Health Hazard Evaluation programs. Labor groups have criticized NIOSH for being unresponsive to worker

requests. Management representatives have

claimed that Health Hazard Evaluations were too

aggressively pursued and that NIOSH research

was of poor scientific quality.

Separation of Research and Regulation

The OSH Act separated occupational health

and safety research activities from standardsetting and enforcement by placing these responsibilities into two different departments of the Federal Government. This may, in part, simply be

the result of the history of Federal activities, which

prior to the OSH Act had been found in both the

Department of Labor and the Public Health Service of HHS and their predecessor agencies. During congressional consideration of the OSH Act

(see ch. 11), labor unions strongly supported designation of the Labor Department as the lead regulatory agency. The congressional debate concerning research focused only on the need to

enhance occupational safety and health research

and to “elevate [its] status” (551).

Separating research from regulatory activity

may also help ensure the quality and objectivity

of the research. On the other hand, separation

may lead to inefficiencies, especially when the

activities of the two agencies are poorly coordinated. One observer argued in 1976 that “the enforcement function and priority setting in OSHA

are barely connected to the research and manpower development mandated for NIOSH” (30).

In 1977, the General Accounting Office concluded

that OSHA and NIOSH needed to improve the

coordination of their activities concerning the development of workplace health standards (501).

In 1978, an Interagency Task Force also made recommendations to better coordinate NIOSH research with OSHA’s needs (228). The two agencies have created mechanisms to coordinate

activities, although OTA has not attempted to determine how well these agencies work together

today.

Besides being separated from OSHA, NIOSH

is lower than OSHA in the Federal bureaucracy.

Since July 1, 1973, NIOSH has organizationally

been part of the Centers for Disease Control. Thus

the Director of NIOSH reports to the Director of

CDC, who in turn reports to the Assistant Secretary for Health, who reports to the Secretary of

HHS. OSHA, on the other hand, is headed by

an Assistant Secretary of Labor who reports directly to the Secretary of Labor.

Some Members of Congress have criticized the

placement of NIOSH within CDC. For example,

in 1973, three Senators argued that this was “contrary to the expressly stated intent of Congress

in creating NIOSH, which was to elevate the

status of occupational safety and health research

in HEW from its relatively low level in 1970. . . “

In addition, they criticized the average Federal

personnel grade levels that had been established

for NIOSH because they were substantially lower

than those for OSHA personnel and personnel at

the Environmental Protection Agency (232).

The geographical location of NIOSH has also

generated considerable interest. In 1981, it was
Ch. 12—Governmental Activities Concerning Worker Health and Safety ● 221

announced that the NIOSH headquarters would

be moved from Rockville, MD, to Atlanta, GA,

where the headquarters of CDC is located. (Most

NIOSH staff, however, continue to work in the

NIOSH laboratories in Cincinnati, OH, and Morgantown, WV. ) In support of the move of NIOSH

headquarters, it was suggested that the scientific

and technical base of NIOSH would be strengthened through greater interaction with other CDC

programs (303). Further, it was thought that

NIOSH would benefit from CDC’s expertise in

disease and health hazard surveillance and that

there would be greater NIOSH involvement in

environmental health. Cost savings of approximately $1.5 million per year were predicted to

result from this action.

But many people from labor, management, academia, and the occupational safety and health

professions believed that moving would be detrimental to NIOSH’s ability to perform its mandated responsibilities. In 1981 and 1982, Congress

attached a restriction on the appropriations for

NIOSH that prohibited this move. At the end of

1982, this restriction was lifted and the move to

Atlanta was completed shortly thereafter.

Federal Spending for Occupational

Health and Safety

Table 12-1 presents the total budgets (in cur

rent dollars and in real, inflation-adjusted dollars)

for OSHA and NIOSH and the authorized personnel ceilings. Figures 12-1 and 12-2 present the

budget totals graphically. Although OSHA’s budget in current dollars has grown over time, in real

dollars it peaked in fiscal year 1979, decreasing

nearly 13 percent by fiscal years 1982 and 1983.

In current dollars the NIOSH budget grew from

1971 to 1980, but since then it has been substantially reduced, both in current, nonadjusted

dollars, as well as in real terms. After adjusting

for inflation, the 1983 NIOSH budget is the lowest

since 1973 and represents a 42 percent decrease

since the peak in 1980. The 1984 budget includes

an increase in current dollars over 1983, largely

because Congress restored NIOSH funding for

professional training programs. The 1985 budget

proposed by the President would reduce the

NIOSH budget by completely eliminating these

funds.

The reduction since 1980 is illustrated in figure 12-3, which shows the percentage changes in

appropriations for several health-related agencies.

Funding of agencies with responsibilities for regulating health and safety in the workplace has increased in current dollars over the last 4 years

(OSHA and MSHA), while overall funding for

NIOSH has consistently decreased. Overall,

NIOSH’s share of Federal spending for occupational health and safety has been declining. In

fiscal year 1974, the NIOSH budget of $35.4 million was about half as much as the OSHA budget of $70.1 million. From fiscal year 1975 through

fiscal year 1980, the NIOSH budget varied from

being 34 to 42 percent as large as the OSHA budget. The President’s budget request for 1985 proposed funding NIOSH at about 26 percent of the

level of OSHA funding.

The authorized numbers of personnel for both

OSHA and NIOSH generally rose from 1971 to

peaks in 1980. From 1980 to 1984, the number

of authorized OSHA positions decreased about

25 percent, while NIOSH positions dropped about

16 percent.

Assistant Secretaries and Directors

Table 12-2 lists the men and women who have

served as Assistant Secretaries for Occupational

Safety and Health and Directors of NIOSH, The

first Assistant Secretary for OSHA was George

Guenther, who had been head of the Bureau of

Labor Standards (the Labor Department predecessor agency to OSHA). He was responsible for

the issuance of OSHA’s first standards and the

beginnings of OSHA’s inspection activity. Within

2 years he was replaced by John Stender, who had

been an official of the Boilermaker’s Union and

a State legislator, but who had no previous professional background in occupational health and

safety. He presided over the growth of the agency,

dramatically increased the number of inspections

conducted, and encouraged the development of

State plans.

In late 1975 Stender was replaced by Morton

Corn, a professor of industrial hygiene at the

University of Pittsburgh, who served as Assistant

Secretary for just over 1 year. Corn took steps

to increase OSHA activity concerning health

standards and to conduct more health inspections.
Table 12.1.--Faderal Spending for Worker Health and Safety

Occupational Safety and Health Administration National Institute for Occupational Safety and Health State programs

Budget Budgeta Budget Budgeta Federal grantsb Federal grantsb

Fiscal (current dollars) (1972 dollars) Personnel (current dollars) (1972 dollars) Personnel (current dollars) (1972 dollars) Inspector

year (millions) (millions) positions (millions) (millions) positions (millions) (millions) positions

1971 ..., . 7.6C 8.2 970 17.7 19.1 501 NA NA NA1972 . . . . . 33.9C 33.9 1,696 26.3 26.3 745 NA NA NA1973 . . . . . 69.3 65.6 1,699 25.9 24.5 611 NA NA NA1974 . . . . . 70.1 61.0 1,830 35.4 30.8 611 NA NA NA1975 ...,. 95.8 74.7 2,435 34.0 26.5 735 16.7 13.0 NA

1976 . . . . . 114.9 84.7 2,494 39.3 28.9 848 28.7 21.2 NA1977 . . . . . 130.2 90.0 2,717 49.7 34.3 898 24.6 17.0 1,1391978. . . . . 138.7 90.2 2,817 56.3 36.6 913 31.4 20.4 1,1161979. . . . . 172.8 106.4 2,944 62.6 38.5 913 37.0 22.8 1,132

1980, . . . . 186.4 103.1 3,015 80.4 44.5 932 40.0 22.1 1,175

1981 . . . . . 209.4 102.4 3,009 67.8 33.2 841 42.3 20.7 1,110

1982. . . . . 195.5 93.1 2,354 62.1 29.6 784 44.1 21.0 1,105

1983. . . . . 206.6 93.1 2,258 57.5 25.9 783 47.6 21.5 1,081

1984d . . . . 212.6 NA 2,259 65.9 NA 785 49.6 NA 1,03619850 . . . . 217.8 NA NA 56.4 NA 785 NA NA NA

 For 1971, Federal Government

 only the grants to the States by Federal For the years this table, these grants were for percent the operating costs of the State program

 financed from the for the Standards Administration

NA–Not 

SOURCE. Office of Technology on data supplied by and 
Ch. 12—Governmental Activities Concerning Worker Health and Safety 223

Figure 12-3.—Percent Change in Appropriations for

Selected Health.Reiated Agencies 1980-84

‘OSHA MSHA’ NIH ‘NIOSH’ CDC ‘ CDC

(excluding

1 I I 1 1

1971 1973 1975 1977 1979 1981 1983 1985

Year

Figure 12-2.— NIOSH Budget 1971-85

Year

He also worked to improve the professional expertise of OSHA staff, especially its inspectors,

who had been criticized for their inexperience.

In 1977, Eula Bingham was named to head

OSHA. She had been a professor of toxicology

and had served on an OSHA advisory committee concerning the coke oven emissions standard.

Agencies NIOSH)

SOURCE Budget of the United States Government

Table 12-2.—OSHA Assistant Secretaries and

NIOSH Directors

OSHA

1. George Guenther . . . . . .

2. John Stender . . . . . . . . .

3. Morton Corn . . . . . . . . . .

4. Eula Bingham . . . . . . . . .

5. Thorne Auchter . . . . . . .

6. Robert Rowland . . . . . . .

NIOSH

1. Marcus Key . . . . . . . . . . .

2. John Finklea. . . . . . . . . .

3. Anthony Robbins . . . . . .

4. J. Donald Miller . . . . . . .

April 1971-January 1973

April 1973-July 1975

December 1975-January 1977

April 1977-January 1981

March 1981-March 1984

July 1984-Present

June 1971-September 1974

September 1974-January 1978

October 1978-May 1981

June 1981-Present

SOURCE Office of Technology Assessment

She acted to eliminate a number of the “nit-picking” standards, for which OSHA had been criticized, and emphasized the development of health

standards and “generic standards” (those that

would cover exposures to a group of substances,

such as carcinogens, or would provide worker access to information, such as employer records concerning exposures, medical care, and chemical

substance identity). She also established the New

Directions grants program and increased the number of OSHA-funded onsite consultative visits,

especially for small businesses.

Theme Auchter, a construction firm manager,

took office in 1981. He emphasized a ‘balanced”

approach to OSHA activities and improved management of agency operations, established a new

approach for “inspection targeting, ” and en-
224 . Preventing Illness and Injury in the Workplace

couraged cooperation with employers, especially

concerning negotiations about citations, fines, and

abatement. Auchter reconsidered a number of the

standards issued in previous administrations, reduced the funding for the New Directions Program, increased the funding for onsite consultation, and encouraged the development of State

programs. He resigned in March 1984.

In July 1984, Robert Rowland was named to

head OSHA. An attorney, he had practiced law

privately before being appointed as the Chairman

of the Occupational Safety and Health Review

Commission. He served in that position from

August 1981 until his appointment as Assistant

Secretary for OSHA.

In June 1971, Secretary Richardson of the Department of Health, Education, and Welfare announced the establishment of NIOSH. Marcus

Key, M. D., previously chief of the Bureau of Occupational Safety and Health in the U.S. Public

Health Service, was appointed as the first NIOSH

Director. He focused on making NIOSH a functioning organization. Key stepped down in September 1974, after 3 years of his 6-year appointment. John Finklea became the second Director

of NIOSH in September 1974 and also served 3

years. He emphasized the production of NIOSH

criteria documents to be delivered to OSHA.

Anthony Robbins, a former Commissioner for

Public Health in Vermont and Colorado, became

the third Director in October 1978. He deemphasized criteria documents and focused on health

hazard evaluations and epidemiological field

studies. He, too, did not complete a 6-year term,

but was fired by HHS Secretary Schweiker in

1981. J. Donald Millar took office as the fourth

NIOSH Director in June 1981. Millar has taken

several steps to improve the quality of NIOSH

research.

THE OCCUPATIONAL HEALTH AND SAFETY ADMINISTRATION

Figure 12-4 presents the organization of OSHA.

The main activities of its national office in Washington, DC, are performed by seven directorates,

which specialize in developing health and safety

standards, coordinating operations of OSHA’s inspectors, providing educational and service programs, monitoring State plans, and furnishing

administrative and technical support. However,

the majority of OSHA staff, including its inspectors, are assigned to area offices that are grouped

into 10 different regions.

OSHA Standard-Setting

Section 5(a)(1) of the OSH Act, the “general

duty clause, “ imposes a general requirement that

workplaces must be kept safe and healthful. It

provides that each employer:

. . . shall furnish to each of his employees employment and a place of employment which are

free from recognized hazards that are causing or

are likely to cause death or serious physical harm

to his employees; . . .

The purpose of the general duty clause is to provide employee protection from some of the

hazards that are not currently addressed by

OSHA’s more detailed regulations. The interpretation of the “general duty clause” is complex and

controversial (see brief discussion later in this

chapter).

Section 5(a)(2), the “specific duty clause, ” requires employers to comply with the more detailed standards issued by OSHA. These standards are Federal regulations that, for example,

require employers to observe certain precautions,

conduct their operations in specified ways, or install and use certain kinds of equipment. The OSH

Act provided OSHA, in sections 6(a), 6(b), and

6(c), with three different methods to issue health

and safety standards. The standards issued under

these three methods have been termed interim,

new or permanent, and emergency temporary

standards (333,408). But many of the “interim”

standards have not been changed since OSHA

began. At the same time, OSHA has taken actions to change some of the “permanent” stand-
Ch. 12–Governmental Activities Concerning Worker Health and Safety ● 225
226 . Preventing Illness and Injury In the Workplace

ards. Mintz (307) suggests that OSHA standards

be termed: startup standards, standards issued

after rulemaking, and emergency temporary

standards.

Startup Standards

Congress mandated that OSHA adopt, without additional rulemakingl

, those health and

safety standards that had already been established

by Federal agencies or had been adopted as national consensus standards (OSH Act, section

6(a)). This authority was limited to the first 2

years after the act went into effect (April 1971 to

April 1973).

The established Federal standards had been

adopted by the Department of Labor using procedures that included publication of the proposed

requirements and provided the public with an opportunity to comment. The national consensus

standards, issued by groups such as the American National Standards Institute (ANSI) and the

National Fire Protection Association, were defined

by the OSH Act as standards created in ways that

allowed the consideration of diverse points of

view and the formation of a substantial consensus or agreement by interested persons (Section

3(9)). During hearings before the passage of the

OSH Act, industry representatives had argued

that the consensus standards were already widely

accepted by industry (300).

Congress concluded that because these established Federal standards and national consensus

standards were already in effect or represented a

voluntary consensus, there was no need for further rulemaking. Rather, the existing standards

could be used to provide a minimum level of protection until OSHA could issue its own standards.

Many believe that the new agency, however,

acted more quickly than required, by completing

work on these standards in only 2 months. Unfortunately, a number of the national consensus

standards adopted by OSHA were outdated, unnecessarily specific, or unrelated to occupational

health and safety. These included a regulation that

prohibited the use of ice in drinking water and

1“Rulemaking” refers to the procedures that Federal regulatory

agencies use for adopting regulations.

a regulation that mandated a specific shape for

toilet seats (406). In 1978, under Eula Bingham,

OSHA rescinded about 600 of these “nit-picking”

provisions that applied to general industry and

about 300 that applied to several special industries. However, the process of revising the startup standards continues.

Of more serious consequence, many types of

hazards are not adequately addressed by the startup standards. A Presidential task force in 1976

estimated that the OSHA machine-guarding

standards (which had been adopted in 1971) covered only 15 percent of the types of machines in

use (276). As of 1984, that standard had not yet

been revised or expanded. In many cases the organizations that wrote the standards adopted by

OSHA in 1971 have revised their standards.

OSHA, however, cannot incorporate these changes

without going through rulemaking.

Moreover, many of the startup standards specified in great detail the kinds of equipment necessary for compliance. As pointed out by the 1976

task force, this can hinder the development of improved control techniques and lead to unnecessarily costly expenditures for compliance. This

task force recommended, and OSHA has accepted, the goal of developing performance standards that require employers to control workplace

hazards without specifying the details of equipment design. (The task force also recommended

that OSHA publish nonmandatory appendixes to

provide information on designs that OSHA considers acceptable to meet its performance standards. )

The startup standards were almost exclusively

safety standards. Most of the relatively few startup health standards had originated in Federal

standards adopted under the Walsh-Healey Act

prior to the creation of OSHA. These included

the Threshold Limit Values for nearly 400 substances that had been set by the American Conference of Governmental Industrial Hygienists

(ACGIH) in 1968. In addition, OSHA adopted

about 20 ANSI consensus standards that set exposure levels for toxic substances. After eliminating the overlap between these two lists, the startup permissible exposure limits covered nearly 400

toxic substances. Since 1971, the agency has

adopted new or revised standards for 23 substances and one physical agent (discussed in the
●

Ch. 12–Governmental Activities Concerning Worker Health and Safety 227

next section). Some of these were revisions of

OSHA’s startup standards. Thus the total number of OSHA-regulated substances stands today

at about 410.

The latest Registry of the Toxic Effects of

Chemical Substances (586) compiled by NIOSH

(as discussed later in this chapter) lists nearly

60,000 separate chemical substances. Not all the

60,000 are found in the workplace and not all are

toxic, but there is uncertainty concerning how

many hazardous substances are missing from the

OSHA list of regulated chemicals. Most of the exposure limits adopted by OSHA have not been

revised, and many are now outdated due to increased knowledge about the hazards posed by

particular substances. Furthermore, all the startup standards set only a permissible exposure limit.

None includes additional requirements for exposure monitoring, medical surveillance, employee

training and education, record keeping, or warnning labels and signs. (In the mid-1970s, OSHA and

NIOSH started actions to add these requirements

in what was called the “standards completion

project.” No regulatory actions were ever completed under that project and it is now “dormant.”

The only result of that effort is a series of NIOSH

publications with recommendations concerning

use, monitoring, surveillance, and protective

equipment for workers exposed to these substances. )

Standards Issued After Rulemaking

OSHA also has the authority to issue new

standards and to modify or revoke existing ones

through informal rulemaking. This is authorized

by section 6(b) of the OSH Act, which provides

for a multistep process. This may start with the

receipt of a criteria document from NIOSH, with

reports from employers, labor unions, or academics concerning a hazard, or with a petition

for a standard from an interested group.

ONHA may convene an ad hoc advisory committee for recommendations. If appointed, such

a committee must have an equal number of representatives from labor and management, as well

as at least one representative from State health

and safety agencies. In addition, other persons

with professional expertise may be appointed to

the committee. For standards affecting the construction industry, OSHA has adopted a regulation requiring consultation with a standing Construction Safety Advisory Committee. Except for

construction standards, OSHA has not used advisory committees to assist in developing standards

since the mid-1970s.

In some cases, OSHA publishes an “Advance

Notice of Proposed Rulemaking” in the Federal

Register to solicit information from the public.

This step, however, is not required.

The first mandatory step is to publish a “Notice

of Proposed Rulemaking” that describes the proposed new rule, modification to existing rules, or

revocation of existing rule, and that gives interested persons and organizations time in which to

comment. An informal, administrative hearing

will often take place, which any interested person or organization can attend to present testimony and to cross-examine other witnesses. The

agency may later receive written, posthearing

comments. After the final decisions have been

made, the agency publishes the text of the standard and a statement of reasons in the Federal

Register.

A standard typically has staggered startup dates

and deadlines. Some provisions go into effect

shortly after publication, while others are delayed

to allow employers time to plan for compliance.

Standards that involve the installation of engineering controls generally allow employers a year or

more to complete installation. For example, the

OSHA lead standard allows some industries up

to 10 years to comply with the requirements for

engineering controls.

The agency is also required to develop an economic analysis of the expected effects of the standard. This analysis and the content of the proposed

and final regulations are now subject to review

by the Office of Management and Budget prior

to publication by OSHA. In addition, after final

publication by OSHA, a major standard is almost

invariably the subject of review by one of the U.S.

Courts of Appeals after an interested party challenges its validity. One major issue in the legal

challenges to 6(b) rulemaking actions has concerned the interpretation of “feasibility” under the

OSH Act, including the extent to which the agency could or must consider employer costs when

setting standards (see ch. 14).
228 ● Preventing Illness and Injury in the Workplace

Emergency Temporary Standards

OSHA is authorized by section 6(c) of the OSH

Act to issue emergency temporary standards

(ETS) that require employers to take immediate

steps to reduce a workplace hazard. As outlined

by the OSH Act, an ETS can be issued after

OSHA determines that employees are exposed to

a “grave danger” and that an emergency standard

is “necessary to protect employees from such danger.” An ETS, issued without providing an opportunity for comments or for a public hearing,

goes into effect immediately upon publication in

the Federal Register. The ETS also initiates the

process of setting a standard under section 6(b),

with the published ETS generally serving as the

proposed standard. The act mandates that a final

standard be issued within 6 months of publication of the emergency standard.

Major OSHA Rulemaking Actions

Table 12-3 lists the major health standards

issued by OSHA since 1971. Through 1984,

OSHA issued 18 separate health standards after

rulemaking, or about 3 rules every 2 years. The

Table 12-3.—OSHA Health Standards

Final

OSHA regulation standard

1. Asbestosa b. . . . . . . . . . . . . . . ., ... , , ... , .,

2. Fourteen carcinogens . . . . . . . . . . . . . . . . . .

3. Vinyl chloridea . . . . . . . . . . . . . . . . . . . . . . . . .

4. Coke oven emissions . . . . . . . . . . . . . . . . . . .

5. Benzenea

. . . . . . . . . . . . . . . . . . . . . ., . . . . . . .

6, DBCPac 

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7. Inorganic arsenic. , . . . . . . . . . . . . . . . . . . . . .

8. Cotton dust/cotton gins . . . . . . . . . . . . . . . . .

9. Acrylonitrilea 

. . . . . . . . . . . . . . . . . . . . . . . . . .

10. Lead. . . . . . . . . . . . . . . . . . . . . ., . . . . . . . , . . .

11. Cancer policy. , . . . . . . . . . . . . . . . . . . . . . . . .

12. Access to employee exposure and medical

records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13. Occupational noise exposure/hearing

conservation. . . . . . . . . . . . . . . . . . . . . . . . . . .

14. Lead—reconsideration of respirator fittesting requirements . . . . . . . . . . . . . . . . . . .

15. Coal tar pitch volatiles—modification of

interpretation , . . . . . . . . . . . . . . . . . . . . . . . . .

16. Hearing conservation-reconsideration . . .

17. Hazard communication (labeling) . . . . . . . . .

18. Ethylene oxide . . . . . . . . . . . . . . . . . . . . . . . . .

6/07/72

1/29/74

10/04/74

10/22/76

2/10/78

3/1 7178

5/05178

6/23/78

10/03/78

11/14/78

1/22/80

5/23/80

1/16/81

11/12/82

1/21/83

3108/83

1/25/83

6122184

%bject of an Emergency TemporaW Standard,

bEmeroencv atandarda were issued for aabeatos h 1971 and 1~

cl ,adi~romo.~hloropropane,

NOTE: Additional details on these standards can be found in table A-1 of

appendix A.

SOURCE: Off Ice of Technology Asaesament.

average time required from first announcement

of proposed rulemaking until final publication

amounts to a little more than 2 years, although

the time for particular standards varied from 6

months to 6 years. (This does not include additional time for resolution of legal challenges after

publication of a final rule, nor does it consider

the standards that OSHA has begun to develop

but has not issued in final form.)

Ten of OSHA’s final actions on health standards established new Permissible Exposure Limits

(PELs) and other requirements for monitoring and

medical surveillance (asbestos, vinyl chloride,

coke oven emissions, benzene, DBCP, arsenic,

cotton dust, acrylonitrile, lead, and ethylene oxide). Two others did not institute or change a PEL:

the“14 carcinogens” standard created new requirements for work practices and medical surveillance for a group of carcinogens, while the

hearing conservation amendment modified an existing standard with requirements concerning

noise monitoring, audiometric testing, hearing

protection, employee training, and record keeping.

Thus 12 separate proceedings resulted in new

or revised requirements concerning 24 specific

substances and 1 physical agent. However, the

hearing conservation amendment, the 1978 standard for benzene, and the requirements for one of

the 14 carcinogens have been ruled invalid by the

courts. (As described in table A-1 in app. A, some

of these standards are still under judicial review

and several are being reconsidered by OSHA. The

application of some requirements in several industries has also been delayed by OSHA or the

courts. )

Three regulatory proceedings established new

“generic” requirements. The access to records

standard created requirements concerning the

keeping of exposure and medical records and for

providing employee access to those records, while

the hazard communication standard requires that

hazardous substances be labeled and information

provided to employees about the substances and

the precautions to be taken, The cancer policy set

a general OSHA policy concerning future standards regulating carcinogens. Finally, three proceedings reconsidered and then modified existing

requirements (respirator fit-testing for lead exposure, coal tar pitch volatiles, and hearing conservation).
. .

Ch. 12–Governmental Activities Concerning Worker Health and Safety 229

Table 12-4 lists the safety standards issued by

OSHA after rulemaking. In OSHA’s first 13 years

there were 26 such regulations. Many of these

safety standards have involved rewriting regulations adopted as startup standards, while two

proceedings have revoked a number of specific

provisions and advisory language that OSHA inherited from the consensus standards adopted in

1971. In general, these changes in safety standards did not impose large increases in costs to

employers. Most of them can be grouped by subject: electrical, mechanical, fire protection, construction, or maritime safety.

Tables 12-3 and 12-4 also indicate the hazards

and substances for which OSHA has published

emergency temporary standards. In all, there have

been seven separate emergency actions concerning 19 specific substances, one ETS concerning an

activity (diving), and an attempt to regulate a

group of 21 pesticides with an emergency standard. (It should be noted that asbestos has been

the subject of an ETS twice-in 1971 and in 1983. )

Of the 11 completed proceedings on specific substances, six began with the issuance of an ETS.

But because an ETS requires employers to take

action before giving them an opportunity to file

comments or objections, these emergency actions

have often been controversial and several of them

have been ruled invalid by reviewing courts.

OSHA’s successes with emergency standards have

been those cases in which labor, management, and

professionals all agreed that a problem existed and

that swift action was appropriate. But in those

cases challenged by employers, the courts have

been reluctant to allow OSHA to impose an ETS.

Box N outlines OSHA’s regulation of vinyl

chloride monomer. See Ashford (30), Kelman

(245), and McCaffrey (290) for short histories of

Table 12-4.--OSHA Safety Standards

Final

OSHA regulation Standard

1.

2,

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23,

24.

25.

26.

Miscellaneous amendments for construction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2/17/72

Cranes/derricks (load indicators) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7/14/72

Roll-over protective structures (construction) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4/05/72

Miscellaneous amendments for construction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11/16/72

Power transmission and distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11/23/72

Scaffolding, pump jack scaffolding, and roof catch platforms . . . . . . . . . . . . . . . 12/02/72

Lavatories for industrial employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5/03/73

Trucks, cranes, derricks, and indoor general storage . . . . . . . . . . . . . . . . . . . . . . . 6/01/73

Temporary flooring—skeleton steel construction . . . . . . . . . . . . . . . . . . . . . . . . . . 7/02/74

Mechanical power presses–(”no hands in dies”) . . . . . . . . . . . . . . . . . . . . . . . . . 12/03/74

Telecommunications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3/26/75

Roll-over protective structures for agricultural tractors . . . . . . . . . . . . . . . . . . . . . 4/25/75

Industrial slings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6/27/75

Guarding of farm field equipment, farmstead equipment, and cotton gins . . . . 3/09/76

Ground-fault protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12/21/76

Commercial diving operations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7/21/77

Standards revocation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10/24/78

Servicing multi-piece rim wheels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1/29/80

Fire protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9/12/80

Guarding of low-pitched roof perimeters during the performance of built-up

roofing work. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11/14/80

Design safety standards for electrical standards . . . . . . . . . . . . . . . . . . . . . . . . . . 1/16/81

Latch-open devices (on gasoline pumps) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9/07/82

Diving exemptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11/26/82

Marine terminals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7/05/83

Servicing of single-piece and multi-piece rim wheels . . . . . . . . . . . . . . . . . . . . . . 2/03/84

Revocation of advisory “should” and repetitive standards . . . . . . . . . . . . . . . . . . 2/10/84

asubject of an Emergency Temporary standard

NOTE: Addltlonal details on these standards can be found in table A-2 In appendix A.

SOURCE” Off Ice of Technology Assessment.
230 ● Preventing Illness and Injury in the Workplace
.-

,

.

.

-+

1,

Ch. 12–Governmental Activities Concerning Worker Health and Safety ● 231
232 ● Preventing Illness and Injury in the Workplace

some of OSHA’s standards. Mintz (307) provides

a number of excerpts of the formal documents

concerning many of these standards.

Enforcement

Inspections and enforcement are the heart of

the regulatory scheme in the OSH Act. Congress

created an agency that is predominantly an enforcement agency conducting unannounced inspections and levying penalties for the “first instances” of violations, as well as for repeated

violations.

The goals of enforcement are both to correct

identified hazardous conditions in inspected plants

and to provide an incentive for uninspected plants

to eliminate or reduce hazards. This second goal

has often been called “voluntary compliance,” although it is misleading to label as “voluntary” actions taken by employers in the face of mandatory

standards with the potential threat of inspection

and civil penalties. “Reinspection compliance” is

perhaps a better term (408). In practice, the incentive for preinspection compliance is actually

quite small, because of both the low probability

of inspection and the low level of penalties (see

discussion later in this section).

Inspection Types and Priorities

OSHA conducts a number of different kinds of

inspections. The first basic division is between inspections for safety hazards and those for health

hazards (table 12-5). The percentage of health inspections increased from about 6 percent in the

early 1970s to a peak of about 19 percent in fiscal

year 1979. This has fallen slightly to a range of

17 to 18 percent in the last three fiscal years. (The

decline would be larger, to about 15 percent, if

“records review” safety inspections were included

in the totals on table 12-5. )

OSHA also classifies its inspections by priority.

It attempts to investigate first those hazards posing the greatest threat to employee health and

safety. The order of priority is:

● Imminent danger

● Catastrophe and fatality investigations

● Employee complaints

● Special inspection programs

● Programed inspections.

Imminent danger inspections are conducted

when OSHA learns of a hazard that can be expected to cause death or serious physical harm

before it could be eliminated through normal enforcement activity. Catastrophe and fatality investigations, second on the list, are spurred by

reports of fatal occupational injuries or of incidents that result in the hospitalization of five

or more employees.

The third priority is employee complaints.

Under section 8(f) of the Act, employees and their

representatives who believe that an employer is

Table 12-5.--Federal OSHA Safety and Health Inspections

Establishment Safety Safety Health Health

Federal OSHA Inspections Inspections Inspections Inspections Inspections

fiscal year (number) (number) (percent) (number) (percent)

1973 . . . . . . . . . 48,409 45,225 93.4 3,184 6.6

1974 . . . . . . . . . 77,142 73,189 94.9 3,953 5.1

1975 . . . . . . . . . 80,978 75,459 93,2 5,519 6.8

1976 . . . . . . . . . 90,482 82,885 91.6 7,597 8.4

1977 . . . . . . . . . 60,004 50,892 84,8 9,112 15.2

1978 . . . . . . . . . 57,278 46,621 81.4 10,657 18.6

1979 . . . . . . . . 57,734 46,657 80.8 11,077 19.2

1980 . . . . . . . . . 63,404 51,565 81.3 11,839 18.7

1981 . . . . . . . . . 56,994 46,236 81.1 10,758 18.9

1982 . . . . . . . . . 52,8188

43,609 82.6 9,209 17.4

1983 . . . . . . . . . 58,516b 48,269 82.5 10,247 17.5

1984 (first six

months) . . . . 30,606’ 25,086 82.0 5,520 18.0

Total. . . . . . . 734,365 635,693 86.6 98,672 13.4

aDogg not Include 8,444 “Records Review” lnsfMCtiOns.

b~g not Include 10,402 “Records Review” inspections.

c~~ not Include 4,9S3 “Records Review” iIWeCtiOnS.

SOURCE Office of Technology Assessment, based on data supplied by OSHA.
Ch. 12–Governmental Activities Concerning Worker Healfh and Safety . 233

violating a health and safety standard may request

an inspection. OSHA schedules inspections to respond to what it determines are valid complaints.

The fourth priority-special inspection programs—

includes programs to give special attention to certain designated hazards and industries. Over the

last decade, the agency has announced several

such programs: the Target Industries Program,

the Target Health Hazard Program, and the National Emphasis Program. Currently, OSHA is

giving special attention to the construction industry, oil-well drilling, and grain elevators.

The lowest priority inspections, but by far the

most frequent, are programed ones. (In the past,

these have been termed “general schedule” inspections. ) Although sometimes called “random inspections, ” they now focus on industries with high

injury rates or those with known health hazards.

Over the past 12 years, OSHA has used a series

of different scheduling systems. For safety inspections, industries are ranked using injury rate information from the Bureau of Labor Statistics

(BLS) Annual Survey. Only industries with injury

rates above the national average for the private

sector are now selected for safety inspections. For

health inspections, OSHA now selects industries

based on the last 5 years of OSHA health inspections. Industries are ranked based on their respective violation rates. Individual establishments are

selected by using commercially available lists of

employers to identify the establishments with 10

or more employees in these selected industries

(635).

One other inspection category should be noted.

Follow-up inspections can be conducted at any

time to determine if workplace conditions have

changed following an inspection. In particular,

OSHA is interested in verifying that abatement

of a hazard has taken place by a scheduled date.

(For information on the types of inspections, see

307,333,408,635. )

OSHA has, through policy changes, varied the

distribution of inspection activity among these

categories. For example, the proportion of inspections triggered by employee complaints increased

from about 10 percent in fiscal year 1976 to over

30 percent in fiscal year 1977, In recent years the

percentage of complaint inspections and followup inspections has declined, while the percentage

devoted to programed inspections has increased

(see table A-5 in app. A).

Enforcement Procedures

The conduct of all these inspections follows the

same general outline. The inspector (formally, the

Compliance Safety and Health Officer) arrives at

the workplace, almost always without advance

warning, presents his or her credentials, and

speaks with the employer, manager, or other person in charge. An opening conference is held with

the employer (and a union representative, if any)

to describe the purpose of the visit. The inspector asks to see any employer-maintained records

that might be relevant (logs of injuries and illnesses, exposure and medical surveillance records,

etc. ).

Then the inspector conducts a “walk-around,”

visiting all or part of the workplace. Both the employer and an employee representative have the

right to accompany the inspector on this tour. The

inspector observes workplace conditions and takes

notes, photographs, and exposure samples as may

be appropriate. After the walk-around, a closing

conference is held (either jointly with both employer and employee representatives, or separately), at which time apparent violations of

OSHA standards are discussed. Normally, citations are not issued at this closing conference, but

are mailed later. This is to allow consultation between the inspector and the area director and to

obtain the results of laboratory analysis of exposure samples.

The Fourth Amendment to the U.S. Constitution generally protects persons from “unreasonable searches and seizures” by government officials. There are certain circumstances in which

police are allowed to search without consent, but

in general a warrant must be obtained for such

a search. The question of whether OSHA is also

subject to these requirements in conducting its

inspections of workplaces was raised most prominently in a 1976 case concerning an Idaho employer, Barlow’s Incorporated. The case was ultimately appealed to the Supreme Court, which

ruled that OSHA had the constitutional authority to conduct inspections, but that if the employer
2.34 ● Preventing Illness and Injury in the Workplace

did not voluntarily consent to the inspection, the

agency would need to obtain a court-issued warrant (see 307,333,408).

Although Congress has never amended the

OSH Act, it has limited OSHA inspection activity by attaching restrictions to OSHA’s appropriations. Currently OSHA is prohibited from conducting programed safety inspections in

establishments with 10 or fewer employees in an

industry with a led-workday rate lower than the

national average; from assessing penalties for the

“first instances” of nonserious violations (unless

10 or more total violations are cited); from assessing penalties against an employer with 10 or fewer

employees who had requested an onsite consultation and is acting to eliminate identified hazards;

from issuing or enforcing standards for small

farming operations (10 or fewer employees); and

from activities that would affect recreational hunting, shooting, or fishing. There are also restrictions on visits designed to monitor State programs

and on OSHA activities on the Outer Continental Shelf (489a).

Current Inspection Targeting

A new procedure for safety inspections was instituted on October 1, 1981. Since then, OSHA

inspectors conducting programed safety inspections have also examined the injury and employment records of the employer and calculated an

average lost-workday case rate for the previous

2 years (or 3 years, for establishments with 10 to

20 employees). If the lost-workday case rate is less

than the national average rate for manufacturing,

the inspection is terminated. The national average injury rate is derived from the BLS Annual

Survey and currently is 4.2 cases per 100 full-time

employees (644). (In table 12-5, these visits are

termed “records review. ” Termination of inspection because of a below-average injury record

does not currently apply to safety inspections in

the construction industry, nor does it apply to

health inspections in any industry.)

In theory, this policy of ending inspections for

“low-hazard” establishments can create an incentive for employers to take steps to reduce injury

rates. It also may help OSHA to use its scarce inspection resources efficiently by concentrating attention on establishments with higher-than-average injury rates. There is concern, however, that

this policy may also serve as an incentive for systematic underrecording of the number of injuries,

although inspectors are instructed to verify the

accuracy of employer injury records.

Compliance with Standards and the

General Duty Clause

Unless they have obtained a variance, employers are required by section 5(a)(2) of the OSHA

Act (the specific duty clause) to comply with the

terms of OSHA standards and regulations. During inspections, inspectors look for any violations,

following the procedures and interpretations

issued by OSHA in its Field Operations Manual,

Industrial Hygiene Manual, and program

directives.

Employers must also comply with section S(a)

(1) of the act–the general duty clause. This has

been used to cover hazards not treated by OSHA’s

more specific standards. There has been controversy concerning the interpretation of this clause

and its application to employers by OSHA.

To prove a violation of the general duty clause,

OSHA must demonstrate that the employer failed

to render the workplace free of a “recognized” hazard that was causing or was likely to cause death

or serious physical harm. OSHA and the courts

have held that a hazard is recognized if the employer had knowledge of the hazard or if it is of

common knowledge in the industry in question

and detectable by the senses or by techniques generally known and accepted by the industry (307,

333,408). OSHA uses a number of different sources

of information to demonstrate that a hazard is

“recognized,” including voluntary standards,

statements of industry experts, implementation of

abatement programs by other companies in the

same industry, manufacturers’ warnings, or

studies conducted by the industry, its employees,

the government, or insurance companies (203).

The Role of OSHRC

An employer who disagrees with OSHA concerning a citation, a proposed penalty, or the date

for abatement of the hazard can file a notice of

contest. Employees also have an independent right

to contest the reasonableness of the length of the
--—

Ch. 12–Governmental Activities Concerning Worker Health and Safety ● 235

proposed period of time for abatement of a hazard. Unless contested within 15 days, an OSHA

citation becomes final. When contested, a hearing is held before an Administrative Law Judge

(ALJ), who is an employee of the OSHRC, an independent review body.

At the hearing before the ALJ, both OSHA and

the employer present their sides of the case. Affected employees and their representatives have

a right to participate in these proceedings. During the period when the citation is under contest,

no abatement is required.

The ALJ examines the evidence and decides

whether to affirm, vacate, or modify OSHA’s citation and proposed penalties. After this decision,

any party can petition the Occupational Safety

and Health Review Commission to review the

decision of the ALJ. The Commission can grant

such review either upon request or by its own

choice. Unless it is ordered to be reviewed within

30 days by a member of OSHRC, the ALJ decision becomes a final order of the Commission.

Any adversely affected person can then petition

a U.S. Court of Appeals for judicial review

(307,333,408).

Informal Conferences

Current OSHA policy encourages the use of informal conferences between employers and OSHA’s

area directors to reach settlements concerning citations. Using such conferences to settle citations

might facilitate prompt abatement of hazards and

improve employee health and safety, as well as

reduce the time spent by government personnel,

employers, employees, and their representatives

resolving contested citations. The first directive

on this was issued by Eula Bingham in 1980.

Assistant Secretary Theme Auchter strongly

encouraged the use of these settlements by

OSHA’s Area Directors. During his tenure as head

of OSHA, the number of informal settlements increased dramatically. But there have been suggestions that some of these settlements may not sufficiently protect worker health and safety (440).

Moreover, if the settlement agreement provides

for eliminating penalties, or reducing them to very

low levels, the incentive for preinspection compliance is virtually eliminated.

Recent court decisions limit the rights of employees and unions to object to settlements that

they view as insufficiently protective. If the employer is no longer contesting the citation, the

rights of employees and unions to object is limited

to the “reasonableness of the abatement period. ”

(In addition, OSHA enforces the provisions of

the OSH Act that prohibit employers from discriminating against employees who exercise any

of the rights provided by the OSH Act. See ch.

15 for a discussion of this protection and other

employee rights. )

Incentives for OSHA Compliance

In theory, OSHA’s enforcement activities will

lead employers to comply with OSHA regulations

and to improve employee health and safety. But

in practice OSHA has never had the resources to

inspect more than a relative handful of the Nation’s workplaces. In addition, the average

penalties levied for violations uncovered in the

“initial” visits to workplaces are very small, especially when compared with the costs of many

types of controls (see box T in ch. 15). Thus, there

is only a weak incentive for employers to comply

prior to an OSHA inspection.

In fiscal year 1983, OSHA conducted about

58,500 establishment inspections and about 10,400

“records review” visits, The various State programs conducted an additional 104,000 establishment inspections and about 2,500 “records review” visits. This makes for a Federal-State total

of about 162,000 establishment inspections and

13,000 “records review” visits. As there are about

4.6 million private sector establishments in the

United States (553), OSHA and the State programs can inspect less than 4 percent of U.S.

establishments.

The probability of a health inspection is substantially less than the probability of a safety inspection. Of all fiscal 1983 inspections, about

21,000 were health inspections. Thus, of each

1,000 establishments, about 31 receive a safety inspection, 3 receive a “records review” visit (which

covers only safety), and fewer than 5 receive a

health inspection.

OSHA and the States do, however, concentrate

their activities on certain industries. For example,
236 ● Preventing Illness and Injury in the Workplace

in fiscal year 1983 the agency conducted about

58 percent of its establishment inspections in construction and about 33 percent in manufacturing.

This would imply about 54,000 establishment inspections in the approximately 321,000 manufacturing establishments nationwide (assuming that

the State plans conduct the same proportion of

inspections in manufacturing as does OSHA).

Therefore, OSHA and the State programs are currently able to inspect a maximum of about 17 percent of manufacturing establishments (assuming

one inspection per establishment in any given

year).

At this rate of inspection, OSHA and the State

programs can inspect each establishment in manufacturing only once every six years. The inspection rate for most other industries with fixed

establishments—transportation, wholesale and

retail trade, finance, services, and agriculture—

is substantially less than this. (Because of the limits

of available statistics, it is difficult to estimate the

probability of inspections at construction sites.)

Even if an establishment is inspected, the penalties for violations are quite low. The average proposed penalty for a “serious” violation (one that

creates a “substantial probability [of] death or serious physical harm”) for OSHA and the State programs in fiscal year 1983 was about $172. Of

course, this is only for violations that are actually

discovered and cited, and does not include the

penalties levied for “other than serious,” “willful,”

“failure to abate,” and “repeat” violations. In fiscal

year 1983, OSHA and the State programs proposed penalties totaling about $13.4 million for

all violations in the 162,000 establishment inspections that were conducted, an average penalty of

about $83 per inspection.

As discussed in chapter 14, employers making

decisions to maximize profits will tend to choose

the least costly alternative. Thus the employer

faces a choice of spending a certain sum to control a hazard and comply with OSHA standards,

or not controlling a hazard and possibly being inspected and penalized for noncompliance. The

decision will be based on a number of factors, including the probability of inspection and the likely

penalties if an inspection takes place and the hazard is detected.

As discussed above, for establishments in manufacturing, the probability of inspection is only

about one in six, while the average proposed penalty for “serious” violations was about $172. A

decision based purely on a desire to maximize profits would be to spend on controls only when the

annual cost of controls is less than the annual expected costs of noncompliance. If it is assumed

that the inspection will detect the violation, the

expected costs for each serious violation equals

one-sixth of $172 or about $29. The average proposed penalty for all violations was $39. With a

one in six probability of inspection, this implies

an expected penalty for noncompliance of about

$6.50. (See 64,127,287, and 685 for similar estimates based on older data.)

Of course, employers may take actions out of

altruistic concern about the health and safety of

their workers or because of the other incentives

described in chapter 15. In addition, for employers

who have been inspected recently, there is the

threat of a repeat inspection. In these cases, the

fines for “failure to abate” an identified hazard

can be very substantial. Thus the incentives for

compliance are much larger after an OSHA inspection. What is clear, however, is that the economic incentive for preinspection compliance is

small.

In fiscal year 1983, compared with fiscal year

1980, OSHA issued 40 percent fewer serious violations, 55 percent fewer repeat violations, and 85

percent fewer willful violations. Consequently,

the total penalties it has proposed declined by

nearly 60 percent (see tables A-8 and A-10 in app.

A). This change has also been accompanied by

a decline in the number of inspections with contested citations (from nearly 12 percent of inspections to less than 2’ percent) and may lead to

prompt abatement of hazards in firms that have

been inspected. However, the reduction in penalties also significantly weakens the small economic

incentive for employers to comply with OSHA

standards.

At least one commentator has suggested that

“OSHA will not be a meaningful deterrent until

the cost of noncompliance becomes greater than

the cost of compliance” (406). Violations of some

requirements for pollution control have been
—. —

Ch. 12–Governmental Activities Concerning Worker Health and Safety 237

penalized with fines that are equivalent to the financial benefits that a firm receives from noncompliance. This began in 1973 in Connecticut, and

at the Federal level with the 1977 Clean Air Act

Amendments. Recently, the Environmental Protection Agency announced plans to extend this

policy to other pollution control requirements,

along with other changes in its policies concerning civil penalties (163).

An Interagency Task Force on Workplace Safety and Health recommended that OSHA develop

procedures to set its penalties at levels equal to

the benefits of noncompliance (228). Such a

change, although clearly providing employers a

larger incentive to comply with OSHA standards,

would probably increase the level of controversy

in OSHA enforcement proceedings.

Public Education and Service

The third major category of OSHA activities

can be called public education and service. This

includes OSHA-funded consultation, the projects

assisted by grants under the New Directions program, and OSHA’s “voluntary protection programs.” These activities, although different in

many ways, are all designed to improve workplace health and safety through methods other

than direct standard-setting and enforcement.

The OSH Act devotes only a few lines to education and service activities, in contrast to the

many paragraphs establishing the new agencies

and specifying the authority of these agencies for

standard-setting, enforcement, and research. Section 2(b)(2) declares that one purpose of the Act

is to

. . . encourage] employers and employees in

their efforts to reduce the number of occupational

safety and health hazards at their places of employment, and to stimulate employers and employees to institute new and to perfect existing

programs for providing safe and healthful working conditions; . . .

Section 21(c) provides specific authorization for

OSHA to conduct “education and training of

employers and employees in the recognition,

avoidance and prevention of unsafe or unhealthful

working conditions” and to “consult with and advise employers and employees, and organizations

representing employers and employees as to effective means of preventing occupational injuries

and illnesses. ”

Consultation

Consultation is the provision of information,

measurements, and advice about controls without threat of citation or penalty. Section 9(a) requires that when OSHA personnel discover violations of standards, the agency “shall with

reasonable promptness issue a citation to the employer” (emphasis added). This absolute language

has been interpreted to prohibit the agency from

engaging in employer consultation at the worksite.

Rather, OSHA personnel must issue citations if

violations are found. This language originated in

response to the history of frequently ineffective

State health and safety agencies, which prior to

1970 often gave inspectors the discretion of issuing or not issuing citations and penalties.

OSHA, therefore, has limited its direct consultation to phone calls, letters, office visits, and

speeches at employer gatherings. Partly from congressional interest, expressed through proposed

legislation and the appropriations process, and

partly from OSHA itself, actions have been taken

to provide for onsite consultation for employers

desiring this service. Because of the section 9 language, Federal OSHA personnel do not themselves conduct these visits. Rather, through

various contractual and grant mechanisms under

sections 18(b) and 7(c)(1), OSHA pays for visits

by State personnel (usually in departments of labor, industry, or health) or private consultants.

The purpose of the onsite consultation program

is to provide employers with a confidential evaluation of the health and safety hazards in their

workplaces, and to recommend means of hazard

abatement. An onsite consultation will let an employer know how the business measures up to the

relevant OSHA standards. This service is provided at no cost to the employer, and priority is

given to requests from small businesses. Visits occur only at the request of the employer and the

results of the visit are provided only to the employer. Consultation is not available to employees or their unions, nor do they have a right to

the information provided to the employer by the
238 . Preventing Illness and injury in the Workplace 

consultant, although employers may voluntarily

turn that information over to employees. This

program has increased substantially from 1975 to

today. In fiscal year 1983, OSHA funded about

28,000 onsite visits, at a cost of $23.4 million (see

table 12-6).

In 1978, the General Accounting Office (GAO)

issued a report criticizing OSHA’s management

of the consultation program, suggesting that

OSHA’s policies were not sufficient to ensure protection of worker health and safety (505). Changes

in the program have been made since then, but

a continuing controversy concerns the relative emphasis of enforcement versus consultation, which

parallels the debate about the relative merits of

mandatory standards versus voluntary efforts.

Many think that Government should engage in

consultation in order to assist well-meaning but

ignorant employers to improve health and safety.

Others suggest that such an approach is largely

ineffective and tends to divert resources from enforcement activities that require, rather than

merely encourage, health and safety improvements.

In 1982, OSHA began an experimental program

in two regions to grant employers a one-year exemption from programed inspections if they apply

for and receive a health and safety consultation.

In 1984 that program was made permanent and

extended nationally. Now employers who agree

to a comprehensive onsite consultation, correct

all hazards detected during the consultation, and

implement the “core elements of an effective safety

and health program” can be given a one-year exemption from programed inspections (355, 648).

However, given the low probability of an inspection, this one-year exemption may not represent

a very large incentive to participate in this

program.

OSHA has also modified its policy concerning

the provision of onsite information by agency inspectors. OSHA still issues citations for apparent violations, but inspectors are now required

to provide “general assistance” to employers in

identifying abatement methods for alleged violations (629). In addition, OSHA has recently announced plans to create “full-service area offices. ”

The goal is the creation of “resource centers” that

employers can use to obtain information on occupational safety and health and on compliance with

OSHA standards.

New Directions Program

The New Directions program was established

by OSHA in 1978 to provide grants to employee,

employer, educational, and nonprofit organizations for the purpose of providing workplace

health and safety training, resources, and services for employers and employees. Grantees have

used these funds to develop educational materials,

conduct training sessions, provide technical assistance concerning health and safety hazards, and

hire technical staff. OSHA has provided the bulk

of the funds for this program, and additional

money has come from the National Cancer Institute, NIOSH, the Federal Emergency Management

Agency, and the National Institute of Mental

Health (636).

The program has recently been cut back substantially, from $13.9 million in fiscal year 1981,

to $6.8 million for fiscal years 1982 and 1983.

(This does not, however, include funds from the

National Cancer Institute that are also included

in this program. ) Similarly, the number of organizations receiving grants has declined from 156

in fiscal year 1980 and 142 in fiscal year 1981 to

100 in fiscal year 1983 (34).
Ch. 12—Governmenta/lActivities Concerning Worker Health and Safety 239

Voluntary Protection Programs

In 1982, OSHA created three programs that

both recognize the achievements of companies

that are “leaders” in providing health and safety

to their employees and provide additional opportunities for OSHA-employer consultation and cooperation. Collectively referred to as “voluntary

protection programs, ” they are individually

named: “Star, “ “Try,” and “Praise.” They are a

mixture of consultation and recognition for

superior performance. In the course of developing a program, OSHA personnel may make an

onsite visit and offer suggestions for program improvement. So far, only a handful of companies

have applied to participate in these programs. Participating companies are exempted from OSHA

programed inspections and are promised expedited action on variance applications.

These programs represent a more cooperative

approach toward employers than OSHA has

taken in the past and are intended to enhance

worker health and safety. Critics of voluntary

protection, on the other hand, are concerned

about the general policy of exempting participating companies from scheduled inspections and

fear that these programs divert OSHA resources

away from inspections and standard-setting activity,

Other Programs

OSHA has also, from time to time, set up cooperative programs with trade associations,

unions, etc. to disseminate health and safety information. In 1982, for example, OSHA agreed

to assist the American Electronics Association

with its efforts to conduct training courses and

prepare booklets on health and safety. Another

agreement was signed with the National Agricultural Chemicals Association to develop a slide/

tape program on good workplace practices for

pesticide manufacture and formulation (632).

OSHA also has an in-house training institute

in Des Plaines, IL. It offers 52 health and safety

courses of 1 to 2 weeks each at no cost to the

students. Since its start in 1972, approximately

40,000 trainees have attended the institute. The

training is generally designed to meet the advanced training needs of OSHA Compliance Officers, State agency personnel, and staff from

other Federal agencies who need health and safety

training. OSHA also makes available a certain

number of classroom spaces for private sector personnel. In fiscal year 1983, approximately 6,700

trainees completed a course at the OSHA institute—nearly 1,850 from Federal OSHA, about

1,650 from State agencies, 2,800 from other Federal agencies, and about 500 from the private sector (34,630,636).

State Programs

Federal Agency

State Programs

and Other

Activities

Many who supported passage of the Occupational Safety and Health Act in 1970 believed that

a Federal program was necessary because existing

State programs were inadequate. But during congressional consideration, a coalition of business

leaders, State officials, a number of State-oriented

members of Congress, and the Nixon administration pushed for the inclusion of State-inn OSHA

programs in the act. It has been suggested that

the act could not have passed without a provision allowing State plans (30,460).

In passing the OSH Act, Congress established

a mechanism that enables States to regulate

worker health and safety subject to Federal monitoring and approval. A State program must, in

general, “provide for the development and enforcement of safety and health standards which

. . . are or will be at least as effective” as Federal standards (OSH Act, Section 18).

The development of a State program is a stepwise process. After application and initial approval from OSHA, the State can begin to enforce health and safety standards. States can adopt

the existing Federal standards, as have 18 of the

24 plans approved before 1984. Half of these 18

also enforce some State standards. The other 6

States enforce mostly their own standards, which

OSHA has deemed to be “at least as effective” as

the corresponding Federal ones.

The first 3 years of a State plan are called the

developmental stage. At the time of initial plan

approval, both OSHA and the State agency have

concurrent jurisdiction—both have the authority

to conduct inspections and cite employers, and
240 ● Preventing Illness and Injury in the Workplace

employers must therefore comply with both Federal and State standards. (Any time after initial

approval, however, as soon as the State is “operational, ” OSHA may suspend its concurrent enforcement jurisdiction through an “operational

status agreement.”) After all developmental steps

are completed and approved, OSHA can issue a

certification of the plan. If the State meets all of

OSHA’s requirements, it becomes eligible for

“final approval” 1 year after certification. Even

after “final approval, ” Federal OSHA still monitors the State program.

The requirement that States maintain a program “at least as effective” as OSHA’s means that

if OSHA issues new or revised regulations, State

agencies must follow suit by adopting the change,

issuing an equivalent change, or making the case

that, for local reasons, there is no need to alter

the regulation. (For example, a State without textile mills need not adopt the OSHA cotton dust

standard. )

There are also procedures for OSHA to withdraw approval and/or reintroduce Federal enforcement for a State that does not comply with

OSHA’s requirements (307,333,408). In all stages

of its operation, OSHA monitors the quality of

the State program. Monitoring may involve “spot

checks” (inspections by Federal personnel after a

State-conducted inspection) or “accompanied”

monitoring visits in which Federal personnel

observe a State inspector during an inspection.

(More recently, a computerized data system has

replaced much of this onsite monitoring. )

History of State Programs Under the OSH Act

The policies of OSHA toward State programs

have varied-sometimes permitting State programs to operate relatively free from oversight,

while at other times setting high standards for

State programs. OSHA’s efforts to allow and encourage or disallow and discourage State programs have also been subjects of litigation

(249,307).

From 1978 to 1983, 24 State programs were in

operation—21 States plus Puerto Rico and the

Virgin Islands covered private and public employment and one program (Connecticut’s) covered

only public employment. In 1984, New York became the 25th State program, although it applies

only to State and local government employees

(table 12-7). “Final approval” had not been

granted to any jurisdiction until 1984, when the

Virgin Islands, Hawaii, and Alaska received this

designation.

An important issue for OSHA policy concerning State programs has been a continuing dispute

concerning the level of funding and the number

of compliance personnel a State must have to meet

the requirements of the OSH Act. In the mid1970s OSHA had interpreted this to mean that

State staff levels need only be equivalent to those

of OSHA, even though OSHA’s staffing levels

were not considered optimal. The AFL-CIO sued

OSHA on this issue.

In a major decision in 1978 (AFL-CIO v. Marshall), the reviewing court agreed with the AFLCIO. According to its opinion, the “at least as effective” requirement applies only to the standards

issued by the State program. For staffing and

funding, the court ruled that Congress intended

that OSHA could use “current Federal levels of

personnel and funds as benchmarks for State programs, provided they are part of a coherent program to realize a fully effective enforcement effort at some point in the foreseeable future.” Thus

while current Federal levels, described by OSHA

itself as only “a percentage of what is really

needed, ” were deemed to be adequate as interim

benchmarks, they were not adequate as goals for

“fully effective” State programs (307).

Table 12-7.–State Programs (1984)

Jurisdlctions with approved plans:

Alaska North Carolina

Arizona Oregon

California Puerto Rico

Hawaii South Carolina

Indiana Tennessee

Iowa Utah

Kentucky Vermont

Maryland Virgin Islands

Michigan Virginia

Minnesota Washington

Nevada Wyoming

New Mexico

Plans cover/rig only pub//c employees:

Connecticut New York

SOURCE: (408).
Ch. 12–Governmental Activities Concerning Worker Health and Safety . 241

In 1980, with the concurrence of the AFL-CIO,

OSHA submitted to the court staffing-level “benchmarks” designed to achieve the goal of State

programs becoming “fully effective” rather than

only “at least as effective” as Federal operations.

This plan would have required the jurisdictions

with approved State programs to increase the total

number of safety inspectors from 849 to 1,154

within 5 years and of health inspectors from 332

to 1,683 (subject to an annual reassessment of the

availability of qualified health personnel). The

agency also released a “benchmark model” that

could be used to generate or revise staffing levels

as necessary. The model considered the hazard

rank of various industry sectors and the number

of establishments of each rank in each State when

calculating the number of programed inspections,

the factor that ultimately determines State health

and safety staffing requirements.

Since then, OSHA has taken steps to change

these required benchmark levels. Beginning in

1981, it has sought congressional approval to prohibit the spending of any funds to achieve State

staffing levels that are greater than current Federal levels. Although enacted in two continuing

resolutions concerning appropriations in fiscal

years 1982 and 1983, this language was not included in the final appropriations actions for those

years (34). In 1984, it was reported that OSHA

is no longer seeking this appropriations language

(350). In 1982, OSHA also formally proposed to

recalculate the benchmark formula. One result of

this would be the lowering of the required State

staffing levels (249).

Pros and Cons of State Programs

A number of arguments have been made for

and against State takeover of OSHA responsibilities. Proponents of State programs argue that

they can adapt to local needs better, are more efficient and more fairly enforced, and continue the

traditional State and local roles in occupational

health and safety regulation. Opponents argue

that, compared with OSHA, these programs are

less effective, understaffed, underfunded, inefficient, less evenly enforced, and more susceptible

to local political influence (408).

Organized labor, especially at the national

level, is principally concerned that many State

programs devote insufficient resources to health

and safety and are ineffective. Although many

people in the business communities of affected

States support such programs, large businesses

with establishments in more than one State often

express a desire for regulatory consistency-something that is hard to achieve with a variety of different State standards. Recent employer support

for an OSHA “labeling” standard, for example,

derives in part from a desire to preempt State and

local laws on this subject.

Local control over job safety and health could

be desirable in its own right, and the use of State

programs can create a combined Federal and State

effort that is larger than the Federal effort alone

could be. But most States do not have the research

capability needed to set standards, nor would it

be efficient to have each conducting the same research for standards development (30). However,

because they can simply adopt Federal standards

verbatim, it is usually not necessary for them to

have such a capability (34).

But the possibility exists that States may compete with each other in order to attract new

businesses by relaxing the enforcement of health

and safety standards. In theory, this should be

restricted by the requirement that State programs

be “as effective as” Federal OSHA. Examination

of inspection data shows that, on average, State

programs issue fewer serious violations and, for

this reason, propose lower penalties overall than

OSHA does. Moreover, the States with programs,

as a group, devote a smaller fraction of their inspection resources to health inspections than does

OSHA (see tables A-l to A-11 in app. A). On the

other hand, State programs conduct proportionately more inspections than OSHA does and some

States have proportionately larger enforcement

staffs, particularly in safety (34). In 1976, the

GAO criticized OSHA’s policies toward the development of State programs and expressed concern that these policies were not sufficient to ensure employee health and safety (500).

The friction over benchmarks, final approval,

and Federal monitoring of State programs reflects

the underlying tension between the national and

the State governments, which historically had

been responsible for job safety and health. Federal policies concerning State programs have re-
242 ● Preventing Illness and Injury in the Workplace

sponded to those tensions, as well as to more general views concerning the rightful role of the

Federal Government.

For example, the 1973 President’s Report on Occupational Safety and Health referred to the approval of 20 State programs in 1973 as a step that

moves the United States closer to the “Federal/State occupational safety and health partnership intended by Congress. ” Assistant Secretary

Bingham took a very different view, stating that

“[t]he Federal agency is given a leadership role

which does not lend itself to a traditional partnership of equality as I believe a number of States

desire.” Thorne Auchter returned to an earlier policy of actively encouraging State programs. In his

words, “It is my belief—and the belief of this

administration—that in the last analysis, local

problems are best addressed by those closest to

them” (249).

Other Federal Agencies

Although OSHA and the State programs are

directly responsible for ensuring the health and

safety of most private sector workers in the United

States, some workers are the responsibility of

other agencies. The OSH Act does not apply to

“working conditions” for which other Federal

agencies and certain State agencies “prescribe or

enforce standards or regulations affecting occupational safety or health” (OSH Act, Section 4). For

example, the health and safety of coal miners is

regulated by the Mine Safety and Health Administration, while protection of certain railroad employees is provided by the Federal Railroad Administration.

Health and safety conditions for most public

sector workers are not directly regulated by

OSHA. State and local employees, however, are

covered by State programs in the 25 States with

approved plans. The heads of Federal agencies are

required by the OSH Act to provide their employees with an occupational safety and health program that is “consistent with” OSHA standards.

Three different Executive Orders have been issued

concerning health and safety protections for Federal Government employees.

Lastly, the regulations issued by several other

Federal agencies also affect job safety and health,

even though workplace conditions are not the primary focus of these agencies. The constellation

of governmental bodies with workplace safety and

health responsibilities is summarized in table A12 in appendix A.

THE NATIONAL INSTITUTE FOR

OCCUPATIONAL SAFETY AND HEALTH

The need to provide for research to identify, Welfare) to carry out research and related activievaluate, and control work-related illness and in- ties. Congress listed several major activities for

jury, to disseminate information to workers, em- NIOSH:

ployers, and health professionals, and to train occupational safety and health professionals did not ●

provoke much controversy during the debate

about passage of the OSH Act. All parties agreed ●

there was overwhelming evidence that scientific

knowledge about work-related injury and illness ●

was lacking, that the supply of trained personnel

was inadequate, and that meaningful statistical

data were unavailable. o

●

The OSH Act established the National Institute

for Occupational Safety and Health within the Dedevelop criteria for recommended occupational safety and health standards;

conduct educational programs to provide an

adequate supply of qualified personnel;

conduct informational programs on the importance of the use of adequate safety and

health equipment;

conduct Health Hazard Evaluations; and

conduct industry-wide studies of the effects

of chronic or low-level exposures.

partment of Health and Human Services (then In contrast to OSHA, most NIOSH personnel

called the Department of Health, Education, and work in only two locations, at the NIOSH facil-
Ch. 12—Governmental Activities Concerning Worker Health and Safety 243

ities in Cincinatti, OH, and Morgantown, WV.

As mentioned earlier in this chapter, NIOSH

headquarters are now in Atlanta, GA. There are

also very small staffs, usually two to three, in the

10 HHS regional offices (located in the same cities as OSHA regional offices).

NIOSH’s organization reflects the various topics of its research and dissemination program.

These activities are conducted by NIOSH’s seven

divisions, each of which conducts research concerning a particular aspect of occupational health

and safety or provides for the dissemination of

information or training and education (fig. 12-5).

For this description, OTA divides NIOSH activities

●

●

●

into three major program areas:

Identification of occupational health and

safety problems;

Development of controls to prevent workrelated illnesses and injuries; and

Dissemination of findings and recommendations and provision of Professional Training and Education. 2

 itself divides its activities into five areas: identification,

evaluation, control, dissemination, and administration (s79). The

first three appear to have derived from the language of industrial

Figure 12-5.—National

The funding for the three activities is not,equal.

Identification now receives the largest share of

NIOSH’s budget, with information dissemination

and control technology research receiving substantially less funding. In addition, although its

mandate extends to both health and safety,

NIOSH has concentrated almost exclusively on

questions of occupational health.

Identification

Identifying work-related illness and injury and

understanding the mechanisms of disease and injury causation involve using the skills of medicine, industrial hygiene, safety engineering, epidemiology, toxicology, and statistics. It is the first

step toward prevention (chs. 3 and 4). The specific NIOSH activities directed toward identification include illness and injury surveillance syshygiene, which refers to recognition, evaluation, and control. OTA

has grouped what NIOSH calls identification and evaluation into

one category, largely because there really are no clear boundaries

between these two activities, and both depend on a variety of professional skills. Moreover, the term “evaluation” is commonly used

in the Federal Government to refer to the process of assessing the

administration and impacts of particular programs. Administration,

the fifth NIOSH program area, is not a research area and is not discussed in detail in this chapter.

Institute for Occupational Safety and Health
244 Preventing Illness and Injury in the Workplace

terns, Health Hazard Evaluations, and NIOSH’s

toxicologic and epidemiologic research programs.

Surveillance

NIOSH surveillance systems identify workplace

hazards and work-related injuries, diseases,

disabilities, or deaths, and generate hypotheses

concerning the possible relationships between

workplace exposures and adverse effects. NIOSH

conducts work-related illness and injury surveillance in several ways. For illnesses, NIOSH’s

activities have included two large surveys of

working conditions and the Health Hazard Evaluation program (discussed in detail below).

Until relatively recently, NIOSH did very little on the identification of the causes of injuries.

Now it collaborates with the Bureau of Labor Statistics and OSHA in conducting work injury surveys, which are special-topic mail surveys of injured workers. Epidemiologic methods for injury

investigation are being developed. National workrelated injury data are being collected in conjunction with the Consumer Product Safety Commission’s National Electronic Injury Surveillance

System.

National occupational hazard and exposure surveys.—The first NIOSH survey of working conditions, called the National Occupational Hazard

Survey (NOHS), was completed in 1974. Presently, a major task of NIOSH’s surveillance program is analysis of data collected in the second

national inventory of potentially hazardous exposures to workplace agents, the National Occupational Exposure Survey (NOES).3 The data for

both of these surveys were collected through visits

to a random sample of workplaces. Potential

exposures to workplace hazards were observed

and recorded during comprehensive tours of these

worksites. The surveyors collected information

on the nature of the potential hazards, the number of workers at risk, and the controls in place

to protect them.

3The word “hazard” in the title of the NOHS survey was changed

to “exposure” in the second survey in part because employers’ representatives argued that the survey was really an inventory of all

potential exposures, of which hazardous ones were only a part.

These surveys represent a large effort. The recent survey, patterned after the first one, covered

a random sample of nearly 5,000 worksites in 67

major metropolitan areas over a 2-year period

starting in 1981. Potential exposure estimates for

the Nation are based on the probability sample

in which over 9,000 chemicals and physical agents

were observed in industrial use. These observations included exposures of workers in 450 separate occupational classifications.

The results of these two surveys can provide

national estimates of potential exposure to workplace hazards by industry and occupational

groups that can be useful for research planning,

for estimating the impact of proposed standards,

and for planning OSHA’s enforcement activities.

For instance, occupational safety and health professionals have used the 1974 NOHS to identify

groups of workers exposed to various hazards or

combinations of hazards. One finding from NOHS

was that over 22 million of the 38 million workers in the survey universe were exposed to at least

one potential hazard.

Trade-name chemical products (products with

a commercial name but often lacking information

about the identity or properties of the chemical

constituents on their containers) are prevalent in

the workplace. Analysis of the NOHS data showed

that potentially toxic substances are frequently

present in them. About 70 percent of 86,000 products identified in NOHS (made by 10,500 manufacturers) had trade names. NIOSH requested

information about the composition of these

approximately 60,000 separate trade-name products from the 10,500 manufacturers. The manufacturers supplied information on 45,000 tradename products. Of these, 40 percent contained at

least one OSHA-regulated substance and over 400

of these trade-name products contained at least

one of the OSHA-regulated carcinogens.

However, while NOHS estimates are the only

national base of information on exposure to potential workplace hazards, they have been questioned for their accuracy, for being nonquantitative, and for their validity. NOHS estimates

for agents for which there is a high degree of

awareness (such as asbestos) sometimes appear
Ch. 12—Governmental Activities Concerning Worker Health and Safety ● 245

at odds with figures put forward by others. Estimates of the numbers of people exposed to lowtoxicity substances, such as sodium chloride,

dominate some parts of the data base, leaving a

casual observer with the impression that the data

are weak for determining exposure to more hazardous substances. Many users have wished for

quantitative estimates of actual exposure levels,

since these would strengthen the data and increase

its usefulness. Collecting actual exposure data,

while theoretically possible, would be expensive

since accuracy and validity would depend on collection and chemical analysis of a large number

of samples taken over sufficient time to make sure

the results were representative of workplace conditions.

The usefulness of NOHS is reflected by requests

for it and reports developed from the collected

data. In fiscal year 1982 alone, there were over

5,000 requests for data from NOHS. Further analysis of potential exposures to hazardous substances, including analysis of trends, will be possible when analysis of NOES, the second survey,

is completed. A similar NIOSH environmental

survey focusing on the mining industry is planned

to comply with the mining surveillance mandate

of the Mine Safety and Health Act of 1977.

Health hazard evaluation and technical assistance programs. —The identification program area

also includes the Health Hazard Evaluation (HHE)

and Technical Assistance (TA) programs. The

HHE program responds to employee and employer requests from the private sector for evaluation

of specific hazards, while the TA program responds to requests from government agencies.

However, the technical aspects of HHEs and

TAs are the same. The purpose of both of these

programs is to “determine toxic effects of chemical, biological, or physical agents . . . in the

workplace” through medical, epidemiologic, and

industrial hygiene investigations of the worksite

of concern. Upon completion of an evaluation,

NIOSH reports the results back to the worker and

to the employer. If the substance proves to be

toxic as it is used and exposure is not covered by

any standard, NIOSH is required to report its

findings to OSHA.

In fiscal year 1981, NIOSH received 513 requests for mining and general industry HHEs, a

10 percent increase over 1980. Twenty-one percent of these requests came from employers, 55

percent from employees or unions, 23 percent

from Government agencies, and 4 percent from

other sources. Twenty percent of these requests

came from establishments with fewer than 100

employees. NIOSH investigators made over 600

site visits and produced 234 final reports documenting HHEs conducted.

In 1978, the General Accounting Office criticized the administration of the HHE program

(503). GAO suggested that NOSH needed to publicize the program more, issue HHE reports more

quickly, establish an evaluation program, and

disseminate HHE reports more widely, When Anthony Robbins was its Director, NIOSH quadrupled the number of evaluations (465). This rapid

growth of the HHE program created some concern in the business community. It has also been

suggested that the the HHE program has reached

too few workers, that the investigations take too

long, that NIOSH has attempted to reach conclusions about toxicity based on too few data, and

that the program has not found many new workrelated illnesses and injuries, especially when compared with the expense of conducting the studies.

In some cases, the data gathered by an HHE

are insufficient to identify a particular cause for

worker health complaints. For instance, individual HHEs concerning health problems from unknown sources of indoor air pollution have seldom identified a causal agent. The accumulated

findings from these studies, however, have

pointed to lack of ventilation as a common factor. Frequently, reported illnesses disappear after

improvements in ventilation.

State surveillance programs.—NIOSH is now

attempting to involve State health departments

in surveillance programs for identifying workrelated illness and injury. After surveying State

Health Officers to learn about their current capabilities for carrying out surveillance and prevention programs, NIOSH established agreements

to cooperate with five States. NIOSH is devising

methods to assign Epidemic Intelligence Service
246 ● Preventing Illness and injury in the Workplace

Officers to State Health Departments for general

epidemiological duties related to preventing workrelated illness and injury.

Epidemiologic and Toxicologic Studies

The goal of epidemiologic and toxicologic

studies is to understand the causes of occupational

health and safety problems and thus reveal areas

for preventive actions. Since 1971, NIOSH has

sponsored a number of studies through its research grants programs and NIOSH staff have

themselves conducted important studies.

NIOSH describes its current research efforts by

referring to its list of 10 leading work-related diseases and injuries. These are occupational lung

diseases; musculoskeletal injuries; occupational

cancers; amputations, fractures, eye loss, lacerations, and traumatic deaths; cardiovascular diseases; reproductive disorders; neurotoxic disorders; noise-induced hearing loss; dermatoses;

and psychologic disorders. As examples of current NIOSH activities, a few studies of lung disease, cancer, and reproductive health are discussed.

Work-related lung disease. -Lung disease is

the highest priority work-related health problem

and includes a number of debilitating diseases.

The health and safety HHS prevention objectives

(see discussion below) set a goal of virtually no

new cases of asbestosis, byssinosis, silicosis, and

coal workers’ pneumoconiosis. NIOSH efforts

concerning lung disease focus on these four diseases plus lung cancers and occupational asthma.

NIOSH studies in this area include animal

testing to study the carcinogenicity of short

asbestos fibers, those less than 5 um in length. The

study lasted 2 years, at which time the animals’

lungs were examined. Asbestos fibers were found

in the lung, but fibrosis, lung tumors, and other

lesions were absent. The researchers concluded

that although short asbestos fibers did not by

themselves appear to cause tumors, there is still

a need for further study of the possible interactions between short asbestos fibers and other substances that cause cancer.

NIOSH researchers have sponsored the development of criteria for the pathologic diagnosis of

pleuro-pulmonary disease associated with asbestos dust exposure and a method for grading

disease severity. An expert committee of pulmonary pathologists assembled in cooperation

with the College of American Pathologists reviewed surigical and autopsy evidence and reached

a consensus as to what the criteria should be.

There have also been investigations of the immunologic aspects of work-related lung disease

to examine the natural defense systems of the lung

and potential ways they are stressed by workrelated exposures. For instance, the effect of certain particulate matter often found in the workplace was tested on the interferon system in a

laboratory experiment. One finding was an association of inhibition of interferon production with

increasing coal rank (coal, that is, with higher carbon content such as anthracite). The growth of

influenza virus, introduced into a treatment system, increased more among those treated with

coal particulate than among controls.

Work-related cancer. —Both laboratory and

epidemiologic studies are conducted to determine

the carcinogenic potential of workplace exposures.

In cooperation with the National Toxicology Program, NIOSH sponsors carcinogenicity assays for

workplace chemicals.

As an example of epidemiologic studies, a

NIOSH retrospective cohort mortality study of

paper and pulp workers found a suggestive increase in lymphatic disease, although associations

with exposure to workplace agents including

wood dust, formaldehyde, sulfur compounds, and

other chemicals were unclear. A proportional

mortality study of automotive workers suggested

that makers of wood dies and models suffer more

often than expected from fatal colorectal cancer,

leukemia, and other cancers.

NIOSH has developed a registry of workers exposed to dioxins that contaminate certain chemicals. Follow-up studies of the members of the

registry will, it is hoped, provide clarifying information about the possible carcinogenicity of dioxin. Although information about the exposure

levels of these “dioxin workers” is limited, at least

some of them were exposed to much higher levels

than any “environmental” exposure through air,

water, or soil. Therefore, the registry will be important in the dioxin controversy. This activity
Ch. 12--Governmental Activities Concerning Worker Health and Safety 247

also illustrates that studies of industrial exposures,

often carried out by NIOSH, have important impacts on other aspects of public health.

Work-related reproductive health problems.—

Studies of work-related reproductive system

health problems include both animal studies and

pregnancy outcome studies among wives of male

workers. NIOSH tested several industrial chemicals—ethylene oxide, propylene oxide, and n-butyl

acetate—for teratogenicity in exposed female animals. Rats and monkeys were exposed to high

levels of these substances prior to breeding. The

test animals had a significant reduction in the

number of fetal implantation sites and live fetuses,

but it was not possible to conclude that these were

definitely teratogenic effects. The investigators did

conclude that in these cases teratologic effects did

not occur at exposure levels below those that are

toxic to the mother animals.

Epidemiologic studies are being conducted

among workers exposed to polychlorinated biphenyls (PCBs) to determine the effect of exposure

on pregnancy outcome among women. Animal

studies of PCB suggest that it is toxic to the fetus

and that it may be teratogenic. NIOSH investigators are conducting a case-control study of

neonatal deaths and infants with low birth weight

among infants of women workers at a capacitor

plant using PCBs.

The effects of carbon disulfide, which is used

to manufacture rayon, on the central nervous system have long been known, but recent studies

have suggested that its health effects also include

increased risk of death and illness from cardiovascular disease and increased risk of reproductive system effects among both men and women.

Sexual dysfunction, loss of libido, semen abnormalities, and impotence have all been found

among exposed male workers and menstrual abnormalities and increased risk of fetal loss and

premature births among exposed female workers.

NIOSH is now conducting a case-control study

of the wives of exposed workers to determine the

potential effects on pregnancy outcome from

fathers exposed to carbon disulfide.

Development of Controls

Development of control technologies includes

developing, assessing, and improving measures

to reduce workplace hazards, especially through

control technology, protective equipment, work

practices, and hazard-detection devices. NIOSH

investigations of control technologies commands

a smaller proportion of NIOSH resources than

any other research area. In fiscal year 1983 only

12,8 percent of the NIOSH budget of $57.5 million and less than 14.0 percent of the 911.7 personyears of staff time were allocated to the controltechnology budget,

NIOSH’s efforts in control technologies are

divided into three research program areas: about

21 percent of the control technology budget is

spent for control systems research; 14 percent for

respirator research; and 3 percent for other personal protective equipment research (table 12-8).

However, the control technology budget also includes funds for performing chemical analyses in

support of NIOSH industrial hygiene studies (37

percent); for developing methods for sampling

and analyzing airborne contaminants (15 percent);

and for testing respirators (10 percent) (584).

Control Systems Research

NIOSH conducts Control Technology Assessments (CTAs) to identify, evaluate, and document

the most effective engineering controls used for

particular hazards within a given industry. Information collected in a CTA is reported back to the

industry so that other plants can use it to solve

problems. Table 12-9 shows some of the areas in

which CTAs have been done. Other research has

been done concerning improved local exhaust ventilation and in the use of air recirculation for general dilution ventilation.

Engineering control research concentrates on industrial processes, since it is here that toxic substance emissions can be controlled. Research is

split by industry: chemicals, mining and minerals,

materials processing, and general industry. Recent research includes evaluation of emission con-
248 ● Preventing Illness and Injury in the Workplace

Table 12-8.—NIOSH Budget for Control Technology

Nonstaff Total

Person (dollars in (dollars in

Program area Projects years thousands) thousands) Percent

Control systems. ... , . . 10 29.0 542.9 1,535.8 20.86

Respirator research ., . . 10 16.7 462.6 1,000.0 13.58

Other PPE . . . . . . . . . . . . 3 4.8 99.3 253.7 3.45

Sampling/analysis . . . . . 12 36.9 1,500.8 2,751.8 37.38

Method development, . . 6 24.2 272.8 1,090.5 14.81

Respirator testing . . . . . 4 15.7 224.2 729.4 9.91

Totals . . . . . . . . . . . . . . 45 127.3 3,102.6 7,361.2 100.00

SOURCE (584)

Table 12-9.—Control Technology Assessments

Performed by NIOSH in Fiscal Year 1982

Completed:

Seals and fittings in chemical processing technology

Nonferrous metals production including aluminum

reduction and nonferrous smelters

Fire building

Foundries

Spray painting

Pesticide manufacture

Dry cleaning

Ongoing:

Dust control in dusty unit operations

Chemical processing unit operations

Unit processes used in general manufacturing

SOURCE: (584)

trol of the suspected carcinogen formaldehyde

(both in its manufacture and as it is found in

adhesives during hot-press wood veneering) and

control of worker exposure to styrene, an agent

that can cause dermatitis and neurotoxic illness,

in boat building plants.

NIOSH is also conducting control technology

research in selected petroleum-refining operations.

Although most processes in this industry are contained, workers may be exposed to toxic substances through leaks, during equipment failure

or maintenance, while collecting quality control

samples, while loading or unloading materials,

and during waste treatment. NIOSH investigated

engineering and work practices at a hydrogen

fluoride acid alkylation unit, at a benzene-loading

facility, and during other processes in petroleum

refining.

CTAs have been conducted in some unit processes. In the pharmaceutical industry, for example, the substances used to manufacture contraceptives are capable of causing gynamastia or

enlarged breasts among both exposed female and

male workers, and menstrual irregularity among

exposed female workers. Because the batches of

these products are relatively small, the process has

not been mechanized and there are many opportunities for worker exposures. Good engineering

controls used in these situations included isolation, highly efficient local exhaust ventilation and,

as an additional safeguard, the use of suppliedair suits.

Other assessments have been made in industries

expected to grow in future years. These include

hazardous waste disposal, semiconductor manufacturing, and fermentation processes. The studies

of waste disposal included investigations of waste

incinerators and automated drum handling.

Toxic materials used or found in the manufacture of microelectronic components include lead,

arsine, phosphine, boron trifluoride, carbon

tetrafluoride, phosphorous oxychloride, and hy -

drofluoric acid. In many cases, NIOSH found

well-designed and effective engineering controls

and ventilation systems for these hazards, but also

discovered one previously unidentified exposure

problem—arsenic off-gassing of silicon wafers impregnated with arsenic.

Fermentation processes are expected to be used

more frequently in biotechnology. NIOSH is investigating the enzyme production industry to

learn which control technologies are most effective in containing potentially hazardous biological

material (582).

Respirator Certification and Research

NIOSH, in conjunction with the Mine Safety

and Health Administration, tests and certifies

respirators. During fiscal year 1982, 44 new res-
Ch. 12—Governmental Activities Concerning Worker Health and Safety ● 249

pirators were evaluated for approval and 60 were

evaluated for extension of approval. Audits were

conducted of 33 off-the-shelf respirators to ensure

that certified respirators continue to meet test requirements. Respirator quality-control programs

are also reviewed to make sure that certified

respirators continue to meet requirements. As

detailed in chapter 8, however, there are many

complaints about respirators and about NIOSH’s

inability to publish new regulations concerning

respirator-testing requirements.

Field testing is conducted to measure certified

respirator performance in actual working conditions. Research is under way on sorbent efficiency

for organic vapor respirators, filter efficiency and

optimum flow rates for aerosol air-purifying respirators, the effects of filter resistance and efficiency on protection factors and reduced air flow

use in powered air-purifying respirators, and the

physiological effects of using respirators simultaneously with protective clothing.

Other Personal Protective Equipment Research

Chapter 8 outlines NIOSH investigations of

various types of personal protective equipment,

including head protection (hard hats), eye protection (protective glasses), face protection (face

shields), - foot protection (steel-toed shoes and

metatarsal guards), hand protection (protective

gloves), motion restraints, and protective clothing. All of those studies were done in the late

1970s. Currently, resource constraints have limited research in this area to chemical protective

clothing. The absence of assurance that personal

protective equipment works as advertised could

be addressed by NIOSH, with sufficient funds and

effort, or by NIOSH in cooperation with other

organizations.

Sampling and Analysis

Analysis of chemical samples is necessary for

many industrial hygiene and medical studies. In

fiscal year 1982, 17,200 exposure samples were

analyzed for 42,000 determinations. About onequarter of the samples were done in NIOSH laboratories and three-quarters on contract.

NIOSH also has a role in laboratory quality

control. Approximately 375 private and government industrial hygiene analytical labs participate

in the NIOSH Proficiency Analytical Testing program, which periodically sends out reference

samples for analysis. For example, a sample of

airborne lead dust would be analyzed by each laboratory, NIOSH then collates results from all of

the participating laboratories and reports them

back in summary so each lab can see how closely

its results match those of other laboratories. Participating in this program and performing analyses within the quality control boundaries for the

tested substances is required for maintaining laboratory certification by the American Industrial

Hygiene Association.

Sampling and Analytical Methods Development

To facilitate accurate and precise assessment of

worker exposure to chemical hazards, NIOSH

develops and refines methods for sampling and

analysis. In 1981, it published the seventh volume

of the Manual of Analytical Methods, which

added 21 methods for monitoring chemical

hazards.

NIOSH has also participated in the development of new sampling devices. In 1981, it developed performance specifications, testing protocol,

and evaluation criteria for passive monitors,

which are devices requiring only the natural motion of contaminant molecules in air, thus saving the costs of sampling pumps. NIOSH and the

Bureau of Mines collaborated in a comparison of

X-ray diffraction and infrared spectroscopy for

analyzing quartz or crystalline silica. These tests

were done to help refine reliable, low-cost analytical methods. Other sampling research has led

to real-time, direct-reading sampling methods.

Such devices, while costing more at the outset,

will reduce the overall cost of monitoring chemical workplace hazards by eliminating the costs,

risk of error, and delays in obtaining results that

are associated with laboratory analysis.

Dissemination

NIOSH disseminates its research findings through

criteria documents, reports, and published papers

informing professionals and the public of identified problems and solutions, as well as through

Health Hazard Evalution reports. Efforts are now
250 Preventing Illness and Injury in the Workplace

being made to disseminate HHE findings to hardto-reach audiences. For example, a finding that

irritating vapors from duplicating machines were

affecting teachers’ aides and that an easy way to

control the exposure was available was disseminated through teachers’ organizations.

The OSH Act provides that NIOSH shall make

recommendations to OSHA concerning health

and safety standards. Since 1971, NIOSH has

transmitted to OSHA over 100 “criteria documerits, ” which contain extensive bibliographies of

available scientific literature on the chemical or

process in question, followed by an analysis and

assessment of the substance’s toxicity and a recommendation to OSHA for a potential standard.

The criteria documentation process has covered

about 151 substances since 1970. Priority for the

substances for which criteria documents were

written was based in part on estimates of the number of workers exposed, the volume of production of the substance, and the severity of toxicity.

The third NIOSH Director, Anthony Robbins,

deemphasized the production of criteria documents in part because many of them “were mostly

toxicological reviews” that “ . . . did not contain

a great deal of epidemiology, which is

needed. They were inconsistent” (482). In addition, as discussed in chapter 13, OSHA has not

issued standards for most of the hazards addressed

by NIOSH criteria documents.

Few criteria documents are being developed

now, but from time to time NIOSH has prepared

other kinds of reports, transmitting them to

OSHA, as well as disseminating them to the public. These include Occupational Hazard Assessments, which contain recommendations but that

are less thorough and less specific than criteria

documents. In addition, NIOSH prepares Current

Intelligence Bulletins, which contain new findings

about workplace hazards, are also published and

transmitted to OSHA, to worker and employer

representatives, and to health and safety professionals. NIOSH also participates in the public

hearings that are part of OSHA’s standard-setting

process and provides recommendations concerning the standard under consideration.

NIOSH technical publications are widely disseminated. In fiscal year 1982, for example, one

research division-the Division of Surveillance,

Hazard Evaluation, and Field Studies—submitted

over 300 reports on industrial hygiene and medical studies to the National Technical Information

Service, published 63 articles in technical journals,

published 3 articles on research findings describing hazards and means for reducing them in industry and labor trade journals, had 6 articles in

the Morbidity and Mortality Weekly Report, published 2 summaries of approximately 80 recently

completed HHEs, and provided over 200 reports

to people requesting information from NOHS.

The OSH Act requires that MOSH publish annually a list of all known toxic substances or

groups of toxic substances, their observed effects,

and the concentrations at which they occurred.

In compliance with this requirement, NIOSH publishes the Registry of the Toxic Effects of Chemical Substances. The current edition contains

218,746 listings of chemical names, of which

59,224 are different chemicals (the rest of the

names are synonyms). The listings are extracted

from the published literature, including journals

published abroad, but are not evaluated for quality, accuracy, or reproducibility, The substance

name is given, followed by its synonyms, chemical data, and toxicity data by the general categories of irritation, mutation, reproductive effects,

tumorigenic effects, and general toxicity. The citation for each toxic effect reported is included so

that the orginal article can be found for further

detail.

NIOSH is also becoming involved in education

to prevent work-related illness and injury. A

health motivation working group has been formed

to examine ways in which NIOSH’s research could

be applied to combine health protection (control

of work-related illness and injury) and health

promotion (improvement of personal health

behaviors).

In addition, NIOSH has responsibility for the

education of occupational safety and health professionals through both direct short-term training and academic programs, It is estimated that

over 5,000 professionals have received training

through these NIOSH programs. (These activities are described in detail in ch. 10. ) Training

grants for Educational Resource Centers have
Ch. 12–Governmental Activities Concerning Worker Health and Safety ● 251

been successful in establishing coordinated multidisciplinary programs. They have received some

attention recently because of proposals by the current administration to eliminate their Federal

funding (102).

NIOSH Priorities

Setting priorities for preventing work-related

illness and injury has been a challenge to NIOSH

management. During John Finklea’s tenure as Director, NIOSH activity was concentrated on the

production of recommendations to OSHA concerning health and safety standards-NIOSH’s

“criteria documents. ” He believed that the criteria

documents should be the primary product of

NIOSH and that once published would be considered public health policy documents that would

force OSHA into setting and revising health

standards.

Anthony Robbins, the next NIOSH Director,

reemphasized criteria documents and focused

NIOSH activity on health hazard evaluations and

epidemiologic studies (465,482). The fourth

NIOSH Director, Donald Millar, has set special

emphasis on efforts to assure high-quality research

and focus research on the most important workrelated problems. He is also working to expand

the participation of State and local health agencies and to increase workplace health promotion

efforts (584).

Present research priorities are influenced by the

HHS Prevention Objectives for the Nation, the

NIOSH list of 10 leading work-related health

problems, and the HHS National Toxicology Program. These are used to identify subjects for criteria document development and to set priorities

for research on hazard assessment and control.

The Prevention Objectives include 20 objectives

for preventing work-related injury and illness.

Thirteen of these have been designated priority

objectives. The Prevention Objectives, shown in

Box

●

●

●

●

●

O, are divided into several categories:

Improved health status (measured by fewer

deaths, injuries, and illnesses);

Reduced risk factors (by implementing hazard controls);

Improved public/professional awareness (as

reflected by increased worker, employer, and

professional knowledge about occupational

hazards);

Improved services/protection (through the

use of generic standards and increased

NIOSH activity in studying hazards); and

Improved surveillance/evahation (including

creation of coding systems and enhancing existing efforts to include occupational factors)

(556).

The NIOSH list of 10 leading work-related

health problems (see table 5 in ch. 3) was compiled by NIOSH’s division directors. Frequency

of occurrence, severity, and amenability to prevention of the work-related injury and illness were

the criteria used for selection (583). This priority

list is used by NIOSH to identify subjects for criteria document development and to set priorities

for research for hazard assessment and control.

It was also published to encourage discussion

among occupational safety and health professionals and to assist them in setting their control priorities. NIOSH intends to collect data on the 10

and periodically update it as conditions change

(581).

The National Toxicology Program coordinates

the Federal Government’s testing of chemicals for

possible human health hazards. Two of its activites are important for NIOSH. First, it carries out

the testing of substances that NIOSH identifies as

possible concerns, and NIOSH contributes to the

costs of those tests. Second, the results of tests

requested by other agencies are also provided, so

NIOSH can evaluate the potential workplace hazards presented by these substances.
[page omitted]

This page was originally printed on a dark gray background.

The scanned version of the page was almost entirely black and not usable.
Ch. 72—Governmenta Activities Concerning Worker Health and Safety 253

’16.

17.

By 1990, generic standards and-other forms of technology transfer should be established, where

possible, for standardized employer attention to such major common problems as: chronic lung

hazards, neurological hazards, carcinogenic hazards, mutagenic hazards, teratogenic hazards, 

and medical monitoring requirements.

By 1990, the number of health hazard evaluations being performed annually should increase tenfold, and the number of industry-wide studies being formed annually should increase threefold. (In 1979, NIOSH performed approximately 450 health hazard evaluations; 50 industry-wide

studies were performed.)

Improved surveillance/evaluation:

-18.

19.

20.

By 1985, an ongoing occupational health hazard/illness/injury coding system, survey, and

surveillance capability should be developed, including identification of workplace hazards and

related health effects, including cancer, coronary heart disease, and reproductive effects. This

system should include adequate measurements of the severity of work-related disabling injuries.

By 1985, at least one question about lifetime work history and known exposures to hazardous

substances should be added to all appropriate existing health data reporting systems, e.g., cancer

registries, hospital discharge abstracts, and death certificates.

By 1985, a program should be developed to: 1) follow up individual findings from health hazard

and health evaluations, reports from unions and management, and other existing surveillance

sources of clinical and epidemiological data, and 2) use the findings to determine the etiology,

natural history, and mechanisms of suspected occupational disease and injury.

“Priority objectives of NIOSH.

SOURCE: (556).

SUMMARY

OSHA and NIOSH were created by the Occupational Safety and Health Act of 1970 and both

began operations in 1971. The separation of regulatory activities from research may help ensure

the objectivity of the research, but it has also been

criticized because oftentimes the two agencies

have not coordinated their activities. After a

period of growth during the 1970s, the budgets

for both OSHA and NIOSH have declined in recent years. After adjusting for inflation, OSHA’s

has decreased nearly 13 percent since its peak in

1979. NIOSH’s has declined 42 percent since a

peak in 1980 and is now lower, in real terms, than

any NIOSH budget since 1973.

OSHA’s main activities are setting occupational

health and safety standards, conducting workplace inspections to ensure compliance with those

standards, monitoring State programs, and providing for several different types of educational

and service programs. Although many of OSHA’s

startup standards have provided some worker

protection, there were many problems with these

standards and OSHA has been slow in revising

them. Since 1971, OSHA has completed 18 separate proceedings for setting health standards and

26 proceedings for safety standards. However, the

scope of some of these standards has been very

limited, and several involved only a rewriting of

requirements that had been issued earlier by

OSHA. Those that involved major changes have

frequently been the subjects of judicial review.

OSHA has also published nine emergency temporary standards, but the courts have been reluctant to support these standards.

OSHA inspection activity has generated a great

deal of controversy because employers can be

compelled to install health and safety control technology. Together, Federal OSHA and the State

programs operating under the OSH Act conducted about 162,000 establishment inspections
254 ● Preventing Illness and Injury in the Workplace

and 13,000 “records review” visits in fiscal year

1983. However, for most workplaces, the threat

of an inspection is quite low. On average, OSHA

penalties are also low, often lower than the costs

of many controls.

OSHA’s public education and service activities

include its consultation program, New Directions

grants program, and Voluntary Protection Programs. All these programs attempt to approach

health and safety in a way that is more cooperative than OSHA citations and penalties. But there

have been concerns expressed about OSHA’s

management of funds in these areas, the quality

of the work performed, and the relationship of

these activities to OSHA’s inspections.

Federal OSHA also monitors the 25 jurisdictions that have assumed responsibility for the

health and safety of all or some of the work force

within their borders. These State programs can

potentially meet local needs better than a centralized Federal agency and can enhance the total

governmental resources devoted to worker health

and safety. But there has been controversy here

too, especially concerning appropriate staffing

levels for these operations.

NIOSH activities are chiefly related to hazard

identification, research on control technology,

and providing for information dissemination and

professional education. The largest share of the

NIOSH budget is now devoted to identification

of hazards. This includes a large survey of

workplaces to determine the extent of potential

exposures to toxic substances, the Health Hazard

Evaluation program, and NIOSH research in epidemiology and toxicology.

Control technology receives a relatively small

portion of the NIOSH budget. This research includes Control Technology Assessments, respirator certification and research, research on other

types of personal protective equipment, as well

as developing sampling and analytical techniques

and performing laboratory analysis of exposure

samples. Information dissemination includes the

preparation of reports on Health Hazard Evaluation, industry-wide studies, Control Technology

Assessments, and guides to good practice. Several NIOSH publications are standard reference

sources for industrial hygiene, and the Registry

of the Toxic Effects of Chemical Substances is a

comprehensive listing of the literature about the

toxicity of over 59,000 different chemicals. NIOSH

has also prepared Criteria Documents containing

recommendations to OSHA concerning new or

revised health and safety standards. Finally,

NIOSH grant programs have provided for the

education of a number of health and safety professionals.
1 3 .

Assessment of OSHA and NIOSH

Activities

\
Contents

Comparison of Recommendations and Standards. . . . . . . . . . . . . . . . . . . . . . . . . . .

Methodology for Comparison . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Results. ....... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Discussion . . . . . . . . . . . . . . . . . . ................... . . . . . . . . . . . . . . . . . . . .

Impacts of OSHA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cost of OSHA Compliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

OSHA’s Impact on Injury Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Trends in Exposure Levels. .

Conclusions About OSHA’s

Impacts of NIOSH . . . . . . . . . .

Summary . . . . . . . . . . . . . . . . . .

Table

13-1.

13-2.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

LIST OF TABLES

Comparison of Protective Levels

McGraw Hill

Safety . . . . . .

Survey of Capital

. . . . . . . . . . . . . . . .

for selected substances. . . . . . . . . . . . . . .

Spending for Worker Health and

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Page

257

258

259

260

262

262

264

26a

269

270

Page

259

263
.—.

Assessment of OSHA and NIOSH

Activities

This chapter presents a discussion of several aspects of the activities of the Occupational Safety

and Health Administration (OSHA) and the National Institute for Occupational Safety and

Health (NIOSH). It is not a complete assessment

of Federal and State activities concerning occupational health and safety, but only a relatively brief

treatment of several important areas. First is a

presentation of the results of an OTA comparison

of the standards and recommendations of OSHA,

NIOSH, and the American Conference of Governmental Industrial Hygienists (ACGIH). Second

is a discussion of estimates of employer investments in health and safety, followed by a summary of the research on the effectiveness of OSHA

in reducing injury rates and toxic exposures.

Finally, there is a short discussion of the difficulties in assessing the results of NIOSH

activities.

COMPARISON OF RECOMMENDATIONS AND STANDARDS

This section discusses an OTA comparison of

current OSHA standards for certain toxic and hazardous substances with NIOSH Recommended

Standards and with the Threshold Limit Values

(TLVs) recommended by the American Conference of Governmental Industrial Hygienists. This

comparison provides an analysis of the stringency

of OSHA standards, and NIOSH and ACGIH recommendations. In most cases, OSHA standards

for chemical exposure appear to be less stringent.

When there is more than one required or recommended level, engineers and designers can find

themselves in a quandary as they seek to design

a productive process and a system for the protection of worker health. Obviously, the designers

must comply with the OSHA standard and cannot choose to comply only with a less protective

recommendation from another organization.

But when the recommendations of NIOSH or

ACGIH are more protective than OSHA standards, it would be desirable, from a health standpoint, for companies to adhere to these more protective recommendations. This is especially true

when building new facilities or rebuilding old

plants, when it is possible to increase worker protection and to take advantage of the reduced costs

of controls introduced as part of the design. At

the current time, however, this is not required.

(As discussed in ch. 16, one option might be to

encourage companies to meet more protective

limits when undergoing “reindustrialization. ”)

OSHA currently has standards for about 410

chemical substances. In most cases, OSHA specifies the maximum levels for employee exposures

(the Permissible Exposure Limits, or PELs). As described in chapter 12, nearly 400 of these standards were adopted in 1971 by OSHA under section 6(a) and consisted of consensus standards and

established Federal standards. In addition, OSHA

has issued 18 separate health standards. Twelve

of these covered 24 specific substances and one

physical agent. Among these 12 standards, there

were 10 that set new or revised Permissible Exposure Limits.

Each year the ACGIH publishes a list of TLVs.

These are recommended to the ACGIH membership by the TLV Airborne Contaminant Committee—17 members and 9 nonvoting consultants

who represent companies and other countries.

ACGIH has a second committee that considers

recommendations for physical agents. Although

qualified technical consultants from unions have

been and are sought by ACGIH (244), unions

have not participated on either of these commit257
258 . Preventing Illness and Injury in the Workplace

tees in recent years because they believe that

standard setting should be a Government activity. The committee members are unpaid and may

meet two to four times each year to deliberate.

New TLVs that are accepted by the membership

at the annual business meeting are placed on a

list of “intended changes” for at least 2 years, during which comments and additional data are requested. At the end of this period the membership votes on whether to add the TLVs to the list

of Threshold Limit Values.

The 1983-84 TLV list contains recommended

exposure limits for 615 chemical substances and

mineral dusts. In May 1984, ACGIH adopted

TLVs for 15 substances, and proposed to add

TLVs for 7 substances not currently on their list

as well as to revise the TLVs for 21 other substances (352). Changes in ACGIH TLVs are not

automatically incorporated by OSHA, even for

the PELs originally based on the 1968 ACGIH list.

As outlined in the Occupational” Safety and

Health (OSH) Act, NIOSH makes recommendations, in the form of Criteria Documents or other

documents, to OSHA concerning health and safety standards. It was apparently intended that

OSHA would issue mandatory standards after receiving recommendations from NIOSH.

A NIOSH list, Recommendations for Occupational Health Standards, details the proposals

made to OSHA since 1971 for exposures to 163

hazardous substances and working conditions.

Five of these concern hazardous working conditions: logging, hot environments, coal gasification, confined spaces, and emergency egress from

elevated work stations. None of these five has

resulted in a completed OSHA rulemaking.1

Ten recommendations concern exposures to

categories of hazardous substances or to harmful physical agents (benzidene dyes, chrysene,

coke oven emissions, fluorocarbon decomposition

products, ethylene thiourea, kepone, noise, pesticides, ultraviolet radiation, waste anesthetic

gases). Only two of these, coke oven emissions

and noise, have resulted in any regulatory action

K)ne other NIOSH recommendation, concerning underwater diving operations, is not included in the NIOSH list. This recommendation was issued in August 1976 after OSHA had already issued

an Emergency Temporary Standard on diving operations. OSHA’S

final standard was published in July 1977.

by OSHA. For coke oven emissions, a standard

was issued in 1976. For noise, OSHA issued a

Hearing Conservation Amendment in 1981 and

revised it in 1983. For both versions of the Hearing Conservation Amendment, however, the published provisions covered only monitoring, audiometric testing, hearing protection, training,

warning signs, and record keeping. The NIOSH

recommendation to lower the Permissible Exposure Limit from an 8-hour time-weighted average

of 90 decibels to 85 decibels has not been acted

on. (The ACGIH TLV for continuous noise is also

85 decibels for an 8-hour exposure. )

Finally, NIOSH has made recommendations

concerning 148 specific chemical substances. But

only 123 of those recommendations include a

specified numerical exposure limit.

Methodology for Comparison

OTA’s analysis compares the protective levels

either recommended or required by NIOSH,

ACGIH, and OSHA, for the 123 specific substances included on the NIOSH list. The use of

the NIOSH data set as a basis for comparison does

not mean that the NIOSH exposure levels are the

most important. The NIOSH data are simply a

convenient source for analysis. (See app. A for

a discussion of the selection of substances and the

major points of inconsistency among these organizations. )

Unfortunately, OSHA, NIOSH, and ACGIH

use different terminology for describing their

standards and recommendations. OSHA refers to

the basic requirement of its health standards as

a “Permissible Exposure Limit. ” This is the requirement that employee exposures be kept below

a specified numerical limit. NIOSH prepares “Criteria for Recommended Standards” and transmits

those recommendations to OSHA. ACGIH uses

the term Threshold Limit Values for its recommended exposure limits.

For these comparisons, OTA has used the term

“Protective Level” to refer to the standards, recommendations, and TLVs. Protective Levels can

be specified in two basic ways:

● time-weighted averages (TWAs), and

● ceiling limits, short-term limits, or peak

levels.
Ch. 13–Assessment of OSHA and NIOSH Activites 259

Protective Levels can have an 8-hour TimeWeighted Average, a Ceiling Limit, or both.

ACGIH recommendations often have TLVs for

both a TWA and a short-term limit. OSHA standards often have only an 8-hour TWA. NIOSH recommendations also generally have just one Protective Level.

A Protective Level is defined to be only the

number listed as the PEL, recommendation, or

TLV. No attempt has been made to quantify the

number of workers exposed either above or below

that Protective Level or to assess the additional

protection provided by monitoring, medical surveillance, and other health and safety activities

often included in standards and recommendations.

This comparison does not quantify all possibIe aspects of worker protection. Rather, it represents only a numerical comparison of the standards and recommendations for a group of toxic

substances. The results of this comparison are expressed in terms of strictness or stringency. A

standard or recommendation is more stringent

than another if the specified numerical exposure

limit is lower. Depending on the nature of the hazard, the expected health effects, the relationship

between exposure and these health effects,

“stringency” and the degree of worker protection

afforded by a standard or recommendation are

usually closely related.

There can be cases for which a more stringent

protective level does not provide improved protection. However, for this comparison, OTA has

not conducted a detailed analysis of expected

health effects and the dose-response relationship

for each of these 123 substances. Thus, the results

only describe the relative stringency of the standards and recommendations of these three organizations.

Results

The rows of table 13-1 present three different

comparisons –OSHA and NIOSH, OSHA and

ACGIH, and NIOSH and ACGIH. To simplify

presentation, in most cases the table provides only

the number of cases for which the first organization listed has a numerical Protective Level that

is less than the corresponding Protective Level of

the second organization.

For example, the OSHA standard (TWA) for

carbon dioxide equals 9,000 mg/m3

, while the

NIOSH recommendation is 18,000 mg/m3 (see

table A-13 in app. A). In this case, the OSHA

standard is more stringent and would be included

in the total number of cases presented in the first

column of table 13-1. For phosgene, both OSHA

and NIOSH have the same protective level for an

8-hour TWA (0.4 mg/m3). Because these TWAs

are equal, phosgene is not included in the first column of the table. But because NIOSH has also

set a Ceiling Limit, while OSHA has not, there

would be an entry in the second column of table

13-I. There will be an entry in column 3 or column 4 only if both the TWA and ceiling limits

are more stringent or equal. (Although not included in the table, the number of times that two

Table 13-l .—Comparison of Protective Levels for Selected Substances

Number (percent) of substances

Both TWA and Both TWA and

T WA

b is more Ceiling Limitb i s Ceiling Limits are Ceiling Limits are

Case stringent more stringent more stringent equally stringent

OSHA standards compared with

NIOSH recommendations. . . . . . . . 28 (23%) 5 ( 4%) 2 ( 2%) 22 (18°/0)

OSHA standards compared with

ACGIH TLVsb 

. . . . . . . . . . . . . . . . . . 11 ( 9%) 12 (10%) 10 ( 8%) 15 (12%)

NIOSH recommendations compared

with ACGIH TLVsb 

. . . . . . . . . . . . . . 35 (28%) 50 (41%) 28 (23%) 15 (12%)

aFOr 123 ~ubstarrce~ for which NIOSH has made recommendations to OSHA.

%WA Is an abbreviation for Time-Weighted Average exposure level. The TWAS compared are typicstly calculated for an &hour workday and a 40-hour workweek. Ceiling

Lirnlts are deflnad for this comparison, in most caaes, as a 15-minute Time-Weighted Average exposura level ACGIH uses the term Short Term Exposure Limit (STEL)

for this. TLV or Thre8hold Llmlt Value is ACGIH’S term for Its recommendations concerning airborne concentrations of substances. See text and app. A for a more

complete discussion.

cThe num~r presented Is the num~r of cases for which the first Organlzatlon ]lsted has a prot~tlve level more Stringent tharl the Swond Orgaflkdioll.

SOURCE: Office of Technology Assessment.
260 ● Preventing Illness and Injury in the Workplace

organizations have identical TWAs or ceiling

limits is included in the following discussion. )

Overall, NIOSH recommendations are more

strict than the OSHA standards. Even when the

Protective Levels are separated into TWA and

Ceiling Limits, OSHA generally permits higher

exposures. Only 28 TWA PELs set by OSHA are

more stringent than NIOSH’s. In all but 2 of those

cases (lead and carbon dioxide) the TWAs used

by OSHA appear to be more stringent because

NIOSH did not set a TWA but only set a Ceiling

Limit. In many cases (22 of the 28), this NIOSH

Ceiling Limit is lower than or equal to the TWA

used by OSHA.

There are, however, 5 instances in which the

OSHA Ceiling Limit is more strict than the NIOSH

one, although in each case this is because NIOSH

has not recommended a Ceiling Limit. There are

33 instances (27 percent) where OSHA PELs are

equal to NIOSH recommendations, either in the

TWA or Ceiling or both. Of these, 22 represent

situations in which both the TWA and Ceiling

Protective Levels are identical.

As mentioned, ACGIH updates its TLVs every

year but OSHA’s PELs remain virtually frozen at

the levels adopted by ACGIH in 1968. Obviously,

then, OSHA PELs and ACGIH TLVs will be equal

in those cases in which ACGIH has not changed

its 1968 levels (15 instances). It is noteworthy that

ACGIH now has TLVs for over 600 toxic and hazardous substances—some 200 substances more

than OSHA regulates.

OSHA standards are stricter overall than ACGIH

TLVs in 10 cases (8 percent). ACGIH has no recommendation for 4 of those substances: acetylene,

DBCP, ethylene dibromide, and petroleum solvents. OSHA’s TWAs are stricter than ACGIH

TLVs in 11 cases (9 percent) and OSHA’s Ceiling

Limits are stricter than ACGIH’s in 12 cases (10

percent). In all but 6 of these, if the TWA used

by ACGIH is weaker than OSHA’s, then the

ACGIH Ceiling Limit is stricter than OSHA’s (or

vice versa). On the whole, instances where OSHA

is more strict occur because ACGIH has not made

any recommendation at all.

NIOSH recommendations are stricter than

ACGIH TLVs for 28 substances (23 percent) out

this is because ACGIH has not set any TLVs for

these substances. NIOSH has stricter TWAs than

ACGIH in 35 cases (28 percent) and stricter Ceilings in so cases (41 percent). NIOSH recommendations and ACGIH TLVs are equal in 15 cases

(12 percent). Sometimes one set of Protective

Levels, such as the TWA, is equivalent and the

other is not (33 cases), For example, the TWAs

for xylene are the same for both NIOSH and

ACGIH, but ACGIH’s Ceiling is stricter than

NIOSH’s. There is only one chemical with an

OSHA PEL and an ACGIH TLV for which NIOSH

has not set an exposure limit (boron trifluoride).

Discussion

These three organizations use different formal

decision rules when setting their standards and

recommendations. However, in practice, many

more informal factors enter into the decisions, including the experience of the individuals involved,

their professional judgments on what is protective of worker health, and the values and goals

for public policy that are held by these individuals

and their organizations.

For OSHA and NIOSH, the formal guidelines

for recommendations and standards derive from

the OSH Act, which appears to distinguish between the “criteria” developed by NIOSH and the

“standards” set by OSHA. NIOSH is required to

develop “criteria” solely on health and safety

grounds, without consideration of the feasibility

of the “criteria. ” OSHA, on the other hand, is

directed to set standards that are “reasonably necessary or appropriate” and, in the case of health

standards, to protect employee health “to the extent feasible. ” (For a discussion of OSHA decisionmaking, see ch. 14. )

ACGIH sets its TLVs at levels “under which it

is believed that nearly all workers may be repeatedly exposed day after day without adverse effect.” ACGIH cautions, however, that because of

variation in individual susceptibility, some workers may still develop an occupational illness from

exposures at a TLV. The TLVs “should be used

as guides in the control of health hazards and

should not be used as fine lines between safe and

of the 123. In 4 instances, as mentioned above, dangerous concentrations” (8).
This comparison shows, in a limited way, that

OSHA has tended to lag behind NIOSH’s and

ACGIH’s Protective Levels. There are several interrelated reasons for this lag. The first, and most

important, is that OSHA is a governmental regulatory agency. Employers can, if they wish, ignore NIOSH recommendations and ACGIH TLVs.

But even though OSHA’s inspection activity is

limited (see ch. 12), OSHA standards can potentially be used as the basis for civil penalties and

required abatement. Thus they receive more attention.

Opposition has often accompanied that attention. Most of OSHA’s health standards have been

challenged in the courts. Resolution of these cases

has taken time–in most cases, several years. The

courts now require that OSHA standards be based

on adequate evidence that the hazard addressed

by the standard poses a “significant risk” and that

compliance is “feasible” for the affected industry.

Moreover, Executive Orders since 1974 have required that OSHA examine the economic impact

of its standards prior to issuing them. (For a discussion of this aspect of OSHA decisionmaking,

see ch. 14. )

In addition, although OSHA is to use NIOSH’s

recommendations as one element for its standardsetting, it is not required to respond to those recommendations within any specified deadline. Beyond this, OSHA has often concluded that the

NIOSH Criteria Documents did not provide an

adequate basis for developing standards. Thus

OSHA has usually developed its own scientific

and technical information concerning hazards and

controls. These factual and legal requirements, as

well as the requirements of the Executive Orders,

have consumed time, stressed OSHA’s limited resources for standard-setting, and slowed the

agency.

NIOSH and ACGIH have their own resource

constraints, too. But they do not have the same

potential for public opposition and legal challenge. They can issue recommendations based on

their judgments about employee protection from

adverse health effects, without formal analysis of

the feasibility or costs of these recommendations.

Ch. 13—Assessment of OSHA and NIOSH Activities ● 261

In 1983, it was reported that a memorandum

had been prepared by OSHA staff recommending that the agency stop working on the development of revised exposure standards for 116 substances that are regulated under OSHA’s startup

standards. OSHA’s activities concerning these 116

chemicals include requests for information on 61

of the chemicals, preparation of advance notices

of proposed rulemaking on 55 of them, issuance

of proposed rules for 23, and hearings on rules

to regulate 9 of the chemicals. According to the

memorandum, a decision to stop working on rules

for these chemicals would be practical, as the

agency no longer has the staff or resources to pursue this activity, Although OSHA has stated that

a decision not to pursue regulation of these chemicals has not been made, there has been little recent activity regarding these 116 substances. The

last hearing to be held on any of them concerned

beryllium, in 1977, and there has been no public

activity on any of the others since 1975 (110,366,

517a).

As discussed earlier, from 1971 to 1984, OSHA

issued 18 separate health standards. But only 12

of these established Permissible Exposure Limits

or other requirements for 25 specific exposures.

Requirements for 3 of these have been overturned

by the courts. Thus, of the approximately 410

OSHA-regulated substances, nearly all are still the

same as those OSHA initially adopted in 1971.

In direct contrast to this is the experience of

some European nations. For example, in July

1984, Sweden issued a revised list of health standards that included 18 revisions of existing exposure

limits and the addition of limits for 22 new substances previously not regulated. This is the result of only 3 years of effort, as the last revision

of the Swedish health standards was published in

June 1981. Although it is generally believed that

the Swedes are leaders in occupational health and

safety, it is difficult to gather quantitative information on actual exposure conditions in Sweden

and the United States. Thus, it is not clear to what

extent the Swedish limits are translated into actual protection. It is clear, however, that the process of revising the exposure limits in the United

States is dramatically slower.
262 . Preventing Illness and Injury in the Workplace

IMPACTS OF OSHA

Cost of OSHA Compliance

There are a number of difficulties and problems

in securing accurate and meaningful information

on the costs of health and safety regulation. These

problems generally plague both estimates of the

costs of any particular regulation or proposed regulatory change and estimates of the total costs of

all OSHA regulations.

First, the basic source of data on the costs of

compliance with regulations is employers, either

because they are the most knowledgeable about

day-to-day conditions and equipment in their

plants or because they have given permission to

outsiders to visit their facilities. But businesses

generally do not arrange their accounting systems

to keep track of all health and safety expenditures.

Although information is sometimes available for

certain health and safety expenses (e.g., the salary of a company physician), there is generally

no account entry for the total expenditures for

health and safety. Thus, estimates of current costs

and predictions of future costs are generally based

on inexact information and guesses rather than

on data that can be verified and audited.

Furthermore, when asked to provide these estimates, there is a tendency for employers to overestimate regulatory costs. Employers have a

strategic interest, if they oppose a particular regulation or Government intervention in general,

in overestimating the costs. In addition, lowerand middle-level managers, when asked how

much a regulation will cost in their areas of

responsibility, will tend to overestimate the costs

because, in the words of a senior official at

ALCOA, “it is better to be under budget than over

budget” (140). Facing the possibility that they will

have to budget expenditures within the estimates

they make, managers may overestimate costs in

order to have a sufficient budget.

Second, compliance cost estimates have generally not been offset by the benefits of health and

safety compliance. In fact, in many cases what

appear as new costs to the business firm are

merely costs that previously had been borne by

workers and society. For example, the costs to a

business of preventing occupational injuries may

merely represent costs previously borne by injured

workers in terms of lost wages, pain, and suffering. In addition, the increased costs to employers

often represent increased revenues for suppliers

of control technologies and an increased number

of jobs for health and safety professionals. Moreover, when complying with regulations, employers often are able to offset, at least partially, the

costs of compliance with improvements in productivity and reductions in the costs of lost wages,

medical care, down time, etc. that are associated

with workplace injuries and illnesses.

Third, there are several difficulties in correctly

separating and attributing health and safety expenditures. The first of these concerns how to allocate the costs of equipment and personnel that

perform multiple functions, including normal

business activity, or that enable compliance with

several regulations. For example, an employer installs a ventilation system that both reduces the

level of a toxic air contaminant and provides heating and air conditioning. What percentage of the

cost of the duct work, fans, switches, installation

costs, etc. should be attributed to the industrial

hygiene function and what percentage is a normal business expense for heating and air conditioning?

A second, and related, difficulty arises most

particularly in attempts to estimate the costs related to existing OSHA regulations or proposals

for new standards. This concerns how to separate incremental costs (those due solely to the presence of regulation) from total costs, which include

spending that would have taken place even in the

absence of regulation. These could include the

costs incurred because of corporate good citizenship, collective bargaining agreements, and fear

of legal liability. For new, more stringent regulations, the distinction is often made between the

total costs of compliance and the incremental

costs for reducing hazards beyond the existing requirements.

Finally, cost estimates generally assume the use

of currently available technologies, neglecting the

potential for cost savings with improvements in

control technology. Over time, industry may
—

Ch. 13—Assessment of OSHA and NIOSH Activities ● 263

learn how to control more cheaply and control

technologies themselves may improve. Thus control may become less costly. Basing the costs on

current technology will thus tend to overestimate

the costs of compliance (33).

Estimates of Total OSHA Compliance Costs

Robert Smith (446) has reported a National

Association of Manufacturers estimate that its

members needed to spend between $35,000 and

$350,000 each to comply with OSHA startup

standards. No other details of the methodology

behind this estimate were given.

The Economics Department of the McGrawHill Publications Co. annually surveys a group

of large companies about actual and planned capital expenditures and about the percentage of their

capital spending that is for employee health and

safety and for air, water, and solid waste pollution control, McGraw-Hill then develops national

estimates based on these survey responses (298).

There is no independent verification of the survey

responses, although a limited check is conducted

to ensure internal validity of survey questionnaires. Information is not collected on annual

operating expenses, but only on capital spending.

Nor is information collected on what companies

would be spending on health and safety even in

the absence of OSHA activity.

The total capital spending for occupational

health and safety was estimated to be $4.5 billion in 1982 and $4.9 billion in 1983, representing 1.4 percent and 1.6 percent of total capital

spending, respectively (table 13-2). When measured in current dollars, capital spending for health

and safety has ranged from $3.3 billion to $6.6

billion (from $2.4 billion to $4.4 billion in 1972

dollars). The latest estimate of investment, about

$5 billion, is only about one-sixth as large as the

National Safety Council estimate regarding the

costs of work injuries alone—over $30 billion each

year (324, 530).

In both current and real dollars the peak for

reported capital spending appeared in 1978. From

1979 to 1983, the expenditure ranged between $2.4

and $2.9 billion (in 1972 dollars). In addition, the

share of total capital spending that has been devoted to employee health and safety, which never

Table 13-2.—McGraw Hill Survey of Capital Spending

for Worker Health and Safety

Health and safety investment

Current 1972 Percent of

dollars dollars a

capital

Year (millions) (millions) spending

1972 . . . . . . 3,279 3,279 2.7

1973 . . . . . . 3,616 3,552 2.6

1974 ... , . . 4,403 4,028 2.8

1975 . . . . . . 3,842 3,044 2.4

1976 . . . . . . 3,415 2,550 2.0

1977 . . . . . . 4,291 3,043 2.2

1978 . . . . . . 6,645 4,439 2.9

1979 . . . . . . 4,317 2,719 1.6

1980 . . . . . . 4,128 2,441 1.4

1981 . . . . . . 5,112 2,848 1.6

1982 . . . . . . 4,503 2,459 1.4

1983 . . . . . . 4,945 2,704 1.6

aAdjuSted to Ig7z dollars using the implicit price deflator for nonresidential wOducers’ durable equipment Economic Reporf of the Preslderrt (1984), table B-3

SOURCE (298)

fell below an average for all industries of 2.0 percent from 1972 to 1978, has been in the range of

1.4 to 1.6 percent for the last 5 years for which

data are available (298). This decline in recent

years in the percentage share of capital spending

devoted to health and safety is similar to the decline in the share of capital spending for pollution control (410).

Another source of information on OSHA compliance costs is a study prepared for the Business

Roundtable by the accounting firm of Arthur

Andersen & Co. They surveyed 48 very large corporations to estimate the incremental costs of

Government regulations of six Federal agencies

in 1 year-1977. The 48 companies were estimated

to incur about $2.6 billion in compliance costs.

Of this, only $184 million or about 7 percent was

attributed to OSHA. About 37 percent of the

OSHA compliance costs were capital costs, 56

percent operating and administrative expenses,

and 6 percent research and development costs

(26).

Wiedenbaum and DeFina have developed what

is probably the most widely quoted estimates of

the costs of Federal regulation. Their estimate for

the total costs of all Federal regulations in 1976

amounted to about $65 billion (669), while for

1979 their estimate was over $100 billion (670).

(See 195,428,470 for criticism of these estimates.)

They did not, however, develop any new or origi-
264 ● Preventing Illness and Injury in the Workplace

nal cost estimates for OSHA compliance. Rather,

their estimate for OSHA was based on the McGrawHill survey plus an estimate of the costs incurred

by universities for OSHA compliance.

OSHA and a number of participants in its regulatory hearings have provided estimates of the

costs of complying with many of the proposals

offered by the agency. The quality of these estimates has been quite variable and has usually been

colored by the controversies surrounding the particular regulatory proposal. Because they have

been especially subject to the difficulties discussed

above, OTA has not attempted to summarize

these estimates.

Impacts on Productivity and Paperwork Burdens

OSHA may also have an impact on economic

productivity by diverting resources from “productive” uses to compliance with health and safety

regulations. Unfortunately, available information

on economic productivity generally does not include the benefits of improved worker health and

safety. But even without considering those offsetting factors, the negative effects of OSHA regulation on traditional measures of productivity

appear to be small.

Denisen (137) has studied the determinants of

U.S. economic growth and has attempted to explain the sources of declines during the 1970s in

the economic growth rate. He estimated the incremental costs of occupational safety and health regulation in three areas: costs of safety equipment

on motor vehicles used by businesses, costs of

mine safety regulation, and the costs of OSHA

regulation. He then estimated the percent of economic inputs (land, labor, and capital) that had

been “diverted” to provide for health and safety

protection. In 1975, the latest year of his estimates, business vehicle safety equipment had

diverted 0.09 percent of inputs, mine safety regulation had diverted 0.24 percent, and OSHA regulation had diverted 0.09 percent, compared with

a 1967 baseline. All three together, then, diverted

0.42 percent of inputs. Thus, if occupational safety and health regulation and other economic inputs had been the same in 1975 as they were in

1967, net output would have been 0.42 percent

larger than what was actually produced.

Thus, the estimated adverse impact of OSHA

on productivity is quite small. Moreover, in some

cases OSHA compliance has been accompanied

by improvements in productivity. As discussed

in box N (in ch. 12) and chapter 16, these cases

include the OSHA standards regulating exposures

to vinyl chloride and cotton dust.

One other area in which Government regulation may have had an adverse impact is in increasing the burden of paperwork on businesses. Concern about the burden of Federal forms and other

record keeping was important in congressional

consideration and enactment of the Paperwork

Reduction Act of 1980 (Public Law 96-511). But

OSHA record keeping is only a very small part

of the total record-keeping “burden. ” For the year

ending in September 1983, the time spent in keeping OSHA-required records is estimated to be 36.9

million hours. This amounts to slightly less than

2 percent of the total for all Federal information

collection activities (171,358).

OSHA'S Impact on Injury Rates

During congressional debates concerning the

OSH Act, one sponsor of the act expressed the

hope that the creation of a Federal regulatory

agency would lead to a 50 percent decline in injury rates (459). Have OSHA standards and inspections reduced occupational injury rates? As

discussed in chapter 3, analysis of injury rate

trends since the creation of OSHA is difficult, but

it is hard to find any large changes in national,

aggregated injury rates that do not appear to be

associated with the effects of the business cycle.

A number of researchers have conducted statistical analyses of the possible effectiveness of

OSHA in reducing occupational injury rates. Because of their greater detail, these studies can provide more information than a simple analysis of

trends. Two basic approaches have been used.

The first is to develop a statistical model to “explain” injury rates and changes in those rates.

Such an explanatory model can include a variable

that measures the activity of OSHA (usually the

number of inspections per year). The analysis can

examine whether changes in injury rates correlate

with OSHA activity. Another use of this approach
Ch. 13—Assessment of OSHA and NIOSH Activities ● 265

— —

is to extrapolate results from before OSHA

isted to predict injury rates. If the actual rates

below those predicted, OSHA may have been

cause.

The second major approach is to compare

exare

the

the

injury rate experience of plants that have-been inspected with those that have not. This approach

encounters difficulties if OSHA tends to inspect

plants with the highest injury rates. A variation

is to compare the injury records of plants inspected “early” in the year with those inspected

“late” in the year. Because the data are collected

annually, the records of “early inspectees” will

probably reflect whatever effect OSHA has had

during the year, while the records for the “late

inspectees” will reflect plant experience before the

inspection. Any “OSHA effect” will be seen the

following year. Although this approach has the

advantage of being able to estimate effects on inspected plants, it will not be able to detect any

deterrent effect of OSHA in plants that have not

been inspected.

In both approaches, researchers must try to correct for other factors that may influence the number of injuries and injury rates. Some of these factors include the kind of industry, the effects of

the business cycle, the pace of production and

overtime worked, the demographics of the work

force (including age, experience, and family income), changes in the administration of workers’

compensation, changes in the practice of medicine, and variations in the mix of industries and

occupations.

In addition, several other factors make the task

of discovering an “OSHA effect” difficult. The

first concerns the low probabilities of inspection,

the low average OSHA penalties, as well as variations in inspection probabilities and penalties

among industries and geographic areas. Second,

many OSHA inspections do not find any violations or any “serious” violations. Research that

groups inspections without violations with inspections that found violations may mask OSHA’s effect on employers who violate OSHA standards.

Third, not all types of injuries are equally preventable by current OSHA safety standards and

OSHA’s inspection activity. Indeed, it is likely

that some types of injuries are better addressed

by the current scheme than others are, and that

other types (e. g., musculoskeletal problems such

as back injuries) are not currently addressed at

all. Analyzing data that aggregates all injury types

together may mask a favorable OSHA effect on

some types of injuries.

Fourth, OSHA’s shift from conducting almost

entirely safety inspections toward conducting

more health inspections may change the expected

OSHA effect on injury rates. Fifth, the effectiveness of Federal OSHA and the various State programs may differ. Analysis of a data set that combines safety and health inspections and that

groups OSHA activity with State program activity may not detect the positive effects or either

OSHA or individual State programs. Sixth, the

effectiveness studies that have been done have

used data from employer-maintained records. If

there are biases in those data, or if employers keep

better records after an inspection than they did

before inspections, the effects of OSHA may be

difficult to evaluate.

To date, research results on this question are

mixed. DiPietro (141) found that inspected firms

had higher injury rates, a result that DiPietro attributed to a tendency for OSHA to inspect more

hazardous plants. Smith (446) used a model to

predict injury rates in several high-hazard industries targeted by OSHA. He found declines over

time, but these were not statistically significant.

In a later study (447), Smith compared early and

late inspections, finding a significant decline in

1973 and an insignificant decline in 1974. McCaffrey (291) used the same methodology and found

no significant OSHA effects in 1976, 1977, or

1978. Cooke and Gautschi (121) compared early

and late inspections in Maine for 1970-76 and

found a statistically significant reduction in the

number of lost workdays per worker.

Mendeloff (300) was able to disaggregate injury

data for California by type of injury. Using a

model to predict injury rates in the absence of

OSHA, he found significant decreases in several

types of injuries he judged more likely to be

preventable by OSHA activity. This parallels research by the State of California that shows large

declines in amputations, explosions, and crushing

injuries (668). Mendeloff found no OSHA effect,
266 . Preventing Illness and Injury in the Workplace

however, for California or the Nation using data

that aggregated all types of injuries.

Two studies have used variables concerning the

level of OSHA inspection activity. Viscusi (658),

using data that did not distinguish between Federal and State OSHA programs, found no significant effect related to the level of Federal activity. His results did reveal, however, a significant

decline in injury rates over time, which may have

been a statistical artifact or the result of a

favorable OSHA effect. Bartel and Thomas (45)

limited their study to States covered by Federal

OSHA, and found that OSHA activity had a significant effect on employer compliance with

OSHA standards, but that this compliance led to

only a modest reduction in injury rates.

Taken together, these results tend to support

the conclusion of chapter 3 that most of the injury rate changes since 1972 have been due to the

effects of the business cycle and are not related

to OSHA activities. (For a more detailed discussion of these studies, see Working Paper #l. )

OSHA has analyzed the effect of one OSHA

standard on the reported frequency of injuries.

Between 1970 and 1978, about 47 injury-producing accidents occurred each year with one type

of wheel rim used on trucks and buses. In 1980,

OSHA issued a new regulation concerning the

servicing of these wheels, and since then the

agency estimates that the frequency of injuries has

fallen by 76 percent, to about 11 per year (631).

A workplace standard issued by the State of

California concerning another type of wheel has

also led to an injury reduction of about 80 percent (631). Although these declines are encouraging, they represent only a very small change in

the total number of work-related deaths from all

causes. Moreover, this appears to be the only case

for which OSHA has reported the actual effects

of any particular safety standard on injury rates.

The Mendeloff (300) and Smith (447) studies

have been used to estimate the possible benefits

in the United States of OSHA safety regulation.

Green and Waitzman (195) have calculated that

the 5 percent reduction in fatalities and a 2 to 3

percent reduction in lost-workday cases found by

Mendeloff translate into a nationwide reduction

of 350 deaths and prevention of 40,000 to 60,000

injuries per year. They also estimated that the

Smith findings of 5 to 16 percent reductions in

injury rates in inspected workplaces imply a reduction of 144,000 to 450,000 injuries in a year

with 180,000 inspections,

Assigning a dollar value to these reductions is

very difficult (see ch. 14). Using one estimate of

the minimum social losses due to disabling injuries, Green and Waitzman (195) estimate that

the benefits of OSHA safety regulation are, using

Mendeloff’s results, at least $408 million to $610

million annually. Smith’s results for lost-workday

cases, they argue, imply monetary benefits of up

to $4.59 billion. The reduction of 350 deaths per

year might be valued at over $5 billion if one

“willingness to pay” estimate of the value of life

is used.

The research concerning OSHA can be compared with research about Federal regulation of

mine safety. The number of fatalities in mining

has fallen during the last half-century. In 1926-

30, a total of 11,175 miners were killed on the job,

while during 1971-75, the figure was 715 (536).

Congressional activity concerning coal mining has

included legislation in 1941, 1952, 1969, and 1977.

Two studies have evaluated this legislation

using aggregated data over time. Lewis-Beck and

Alford (270) examined fatality rates from 1932 to

1976 and concluded that Federal legislation passed

in 1941 and in 1969 significantly diminished the

risk of fatal injuries in mining, but that the 1952

legislation had no significant impact on fatality

rates. Weeks and Fox (665) concluded that there

had been no change in underground fatality rates

from 1950 to 1969, but a significant decline from

1970 to 1980. This decline in mining fatality rates

may have recently reversed. Weeks and Fox found

that in 1981 the fatality rate was significantly

higher than would be expected from the rates from

1970 to 1980.

Three other studies have used more detailed information to control for nongovernmental factors

that influence injury rates in mining. Boden (63)

found that Government inspections reduced injuries and fatalities for the period 1973-75. Connerton (114), using data from 1965 to 1975, found

that the 1969 Coal Act had reduced fatality rates,

but that nonfatal injury rates had stayed the same
Ch. 13—Assessment of OSHA and NIOSH Activities ● 267

or increased slightly. Neumann and Nelson (327)

concluded that the 1969 act had significantly reduced fatality rates (they estimated that in 1976

it had been lowered by 9 percent), but that nonfatal accident rates had risen. It is not completely

clear why fatality rates have fallen while nonfatal

injury rates have increased since the 1969 act. Part

of the reason may be improved reporting of nonfatal injuries (536).

Several reasons have been suggested to explain

why mine safety regulation appears to have been

more effective than OSHA’s safety regulation in

nonmining industries. First, the funding of the

Government agencies has been greater for mine

safety, about $150 per worker, as opposed to $3

per worker in general industry. Second, inspection coverage is much greater. Every coal mine

is inspected every year—at least twice a year for

surface operations and at least four times a year

for underground operations. Third, the hazards

of mining are more similar from establishment to

establishment than for the wide variety of industries covered by OSHA. Thus, standards and inspections can be more narrowly focused. Finally,

mine safety regulations require mandatory safety

training of all miners, which includes both training for new employees and refresher training for

current employees (530).

Some critics believe that safety regulation itself

represents the wrong approach to the problem of

workplace injuries; they suggest injury taxes,

workers’ compensation, and tort liability as preferred alternatives (see discussion in ch. 15 and

16). Moreover, some have criticized OSHA’s safet y standards because they mostly concern equipment and not worker activities. OSHA’s safety

inspections can only detect relatively permanent

features of the workplace and not the transient

hazards that lead to many injuries. Thus, these

critics claim, it is not surprising that the studies

on OSHA’s effectiveness have found only limited

impact or no significant impact at all.

For example, Mendeloff (302) found that only

13 to 19 percent of the 645 deaths reported in 1976

in California were related to violations of safety

standards. He then asked a panel of safety engineers to review the written reports of these cases

to determine if the violations would have been

detected by an OSHA inspection on the day before the accident. Based on the panel’s evaluation,

Mendeloff concluded that only 55 percent of the

serious violations would have been detected.

The California Department of Industrial Relations has analyzed occupational injuries and

reports that between 30 and 50 percent of the injuries examined in several different industries

could have been prevented by compliance with

standards. Nearly all of the remaining injuries,

they concluded, could be prevented by improved

training and education (84, 85, 86, 87, 88, 89).

Bacow (37) concludes that most injuries cannot

be prevented by OSHA activity. To reach this he

relies on studies of “unsafe acts” and “unsafe conditions” (summarized in ch. 4) and two studies

in Wisconsin and New York that found violations

of standards to be related to, at most, 30 percent

of nonserious accidents and 57 percent of fatalities. A Federal Interagency Task Force on OSHA

concluded that only about 25 percent of workplace fatalities could be prevented by current

OSHA standards (228).

However, the information contained in inspection reports can be limited, especially for determining injury causes and in designing preventive

measures. Moreover, often these studies do not

consider how changed standards could prevent

injuries. Many of these studies either explicitly or

implicitly rely on the belief that most accidents

are due to “unsafe acts” by workers. But, as

pointed out in chapter 4, oftentimes changes in

equipment and workplace design can prevent

these “unsafe acts” from occurring or reduce the

potential for injury from “human errors.” Similarly, new standards concerning design and installation of equipment might increase the proportion of injuries that are deemed “preventable. ”

In fact, several of these studies automatically

exclude motor vehicle fatalities as “not preventable.” Current OSHA standards do not generally

address motor vehicle safety, but there are technologies available to reduce the incidence of

deaths in vehicle crashes (664). These could be

mandated by the Federal Government, probably

through regulations issued by the National

Highway Traffic Safety Administration.
268 ● Preventing Illness and Injury in the Workplace

Critics of safety standards frequently point to

the importance of worker training for preventing

injuries. Industrial leaders in occupational safety

also emphasize worker training programs. Although perhaps more difficult than regulating machinery design, OSHA could encourage or even

require safety training programs. Thus, new

standards that improve the design of equipment,

address hazards not currently regulated, or that

improve training programs may have a beneficial

effect on injuries.

Trends in Exposure Levels

It is often asserted that exposures to toxic substances have been going down over time. However, data that would permit evaluation of this

claim are scarce. Some individual firms have conducted industrial hygiene measurements for some

time (see 215 for several examples). But it is not

clear, even when records from these firms have

been maintained and are available, that it would

be appropriate to generalize from their experience.

Moreover, while some exposures have declined,

others have risen.

The analysis of exposure levels over time could

be used to measure the impact of OSHA. Of

course, this evaluation encounters similar, but not

identical, problems to those found when evaluating OSHA’s impact on injury rates. For hazardous exposures, however, comparatively little research has been conducted to identify the factors

that influence exposure levels.

Mendeloff (301) analyzed information contained in the OSHA Management Information

System about OSHA health inspections for asbestos, trichloroethylene, silica, and lead from 1973

to 1979. Although there are a number of limitations to those data, the data show substantial declines in asbestos exposures over this period. For

trichloroethylene, silica, and lead, Mendeloff’s

analysis reveals no major changes over time.

Using OSHA inspection data, Carol Jones (237)

has also found declines in asbestos exposures. She

estimates that the decline in average exposures

from the period 1972-76 to 1977-79 amounted to

about three fibers per cubic centimeter. This exposure decline is equal to the decline in 1976 of

the permissible exposure limit from five fibers per

cubic centimeter to two fibers per cubic centimeter

and thus may be linked to the OSHA standard.

However, other factors, particularly the increase

in the number of lawsuits concerning asbestosrelated disease, may also have contributed (see

ch. 15).

It has been estimated that the OSHA asbestos

standard issued in 1972 would result in a reduction of between 630 and 2,563 deaths per year,

resulting in social cost savings, in 1970 dollars,

of between $110 million and $652 million per year

(432). These totals may underestimate the benefits

of the asbestos standard (433). In the case of vinyl chloride, exposures declined substantially after

the issuance of a new, more stringent OSHA

standard (see box N). It has been estimated that

this standard would prevent about 2,000 deaths

over the years 1976-2000 (32).

Two case studies commissioned by OTA for

this assessment also show favorable effects after

the issuance of new, more stringent OSHA health

standards (see ch. 5 for a fuller discussion). Ruttenberg (413) reports that cotton dust exposures

have declined substantially in the past few years,

halving the number of workers who were exposed

above the new permissible limit. Several textile

mills appear to be completely in compliance, while

others fully expect to be in the near future. In addition, these changes appear to have been accompanied by or created by the installation of new

technologies that both decrease employee exposures and increase productivity.

Goble, Hattis, et al. (184) report that in the last

two years there have been large declines in both

employee exposures to lead in the air as well as

in measured employee blood lead levels. For example, the percentage of workers exposed above

200 micrograms/ma in primary smelting has declined by nearly 20 percentage points. Blood lead

levels have declined even more dramatically. New

OSHA standards for vinyl chloride, cotton dust,

and lead have clearly r-educed workplace exposures.

Conclusions About OSHA'S Impacts

OSHA’s activities can be grouped as standardsetting, enforcement, and public education and

service (see ch. 12). OSHA has had the resources

to develop only a few new standards each year.
Ch. 13—Assessment of OSHA and NIOSH Activities . 269

But many of its revised safety standards (see table

12-4 in ch. 12) have been limited in their scope

and have not addressed major workplace hazards.

There are many areas for which standards could

be issued, to improve equipment design, address

hazards not currently covered, and establish

workplace training programs. Moreover, many

of the current safety standards most frequently

cited by OSHA inspectors are only rarely involved in workplace fatalities (302).

Many critics of OSHA’s safety standards, however, believe that there must still be a role for

health standards (446, 685)). Indeed, analysis of

several of OSHA’s health standards reveals substantial reductions in workplace exposures, reductions that should lead to improved worker health.

However, analysis of OSHA standards and the

recommendations of ACGIH and NIOSH reveals

that OSHA’s adoption of health standards has

lagged behind professional recommendations.

Criticisms about OSHA’s health standards are

less likely to be about whether they are needed

than about the desirable level of protection. In

particular, employers have been concerned that

OSHA has not taken account of the costs of these

standards (see ch. 14), or that OSHA requires the

use of engineering controls to reduce or eliminate

these hazards, instead of allowing the use of personal protective equipment (see ch. 9). Labor, on

the other hand, has criticized the slow pace of

standard-setting, as well as the increasing attention to the predicted costs of standards.

Finally, OSHA and the State programs have

been able to inspect (combining health and safety

inspections), at most, 4 percent of all establishments and less than 20 percent of manufacturing

establishments each year. In addition, the penalties for violations are, on average, very low, and

in most cases, much smaller than the potential

costs of controls. Because of the low frequency

of inspection and the low penalties, it is particuIMPACTS OF NIOSH

OTA has divided NIOSH research activities

into three categories: hazard identification, development of controls, and dissemination of inforlarly important that the people who are always

in the workplace—workers and managers—be

fully informed about occupational hazards. In addition, steps can be taken to provide other incentives to ensure that appropriate control technology is installed (see chs. 15 and 16).

Analysts can disagree on the number of cases

of occupational disease and injury that the current regulatory scheme may be able to prevent.

But, in practice, there have been substantial

limitations on these regulatory activities. Any

changes in this, however, would require agreement by Congress and the executive branch to increase OSHA staff and funding, as well as to expand its ability to influence business decisions on

workplace investments and operations.

There is a general belief that the presence of

OSHA has increased manager and worker awareness of occupational health and safety. Kochan,

et al. (253) report, from interviews with company

and union officials, that “management has assigned a higher priority to plant safety, the ability

of the union to influence management decisionmaking on safety issues has increased, and the role

of the union-management safety committees has

been bolstered” since the passage of the OSH Act.

This increased attention has also created a need

for health and safety professionals and probably

increased their role in company decisionmaking.

The presence of a Federal regulatory agency may

lead employers to anticipate potential health and

safety problems and solve them before regulatory

action becomes necessary. The OSH Act also created new rights for worker information and participation concerning health and safety. Although

all these changes may be desirable, it appears that

OSHA activity has, thus far, not had a very large

effect on injury rates. It has had some effect on

several clearly defined health hazards, but its effects on the many hazards it has not addressed

are still in doubt.

mation (see ch. 12). Assessing the impact of

NIOSH in these areas is even more difficult than

assessing that of OSHA. In theory, quantitative
270 ● Preventing Illness and Injury in the Workplace

measures of inspection activity and injury rates

can be analyzed although, of course, there are

great difficulties in doing so. But the impact of

an agency that conducts research is not subject

to even these limited measures. In fact, quantitative measures can be especially misleading”

when assessing research. It is not the number of

studies completed or papers published that is important, but the quality of the research.

Does this research and dissemination contribute to the advance of knowledge in the field of

occupational health and safety? Are the epidemiologic and toxicologic studies based on welldesigned protocols followed by comprehensive

and accurate data collection? Can the studies be

reproduced? Do the NIOSH-developed sampling

and analytical methods provide accurate and valid

results? Do the control technologies developed or

described actually work as indicated? Is the information provided by NIOSH accurate and useful? Are the educational programs sponsored by

NIOSH worthwhile? Finally, do all these activities lead to improvements in working conditions

and in the health and safety of the work force?

In the late 1970s, some concern was expressed

that the quality of NIOSH research was suffering (primarily following criticism by affected companies and industrial consultants of a NIOSH

study of workers exposed to beryllium). When

Donald Millar became Director, he took several

steps to improve NIOSH research. One of these

was the establishment of a Board of Scientific

Counselors to advise the Director on all aspects

of research conducted by NIOSH. The Board consists of 10 scientists who are knowledgeable about

occupational safety and health research. The

board has only recently been appointed and held

its first meeting in early 1984. Although the appointment of a board is a concrete step, it is not

SUMMARY

An OTA comparison of the standards and recommendations from OSHA, NIOSH, and ACGIH

reveals that OSHA has tended to lag behind the

recommendations of both NIOSH and ACGIH.

OSHA’s startup standards included nearly 400

clear what effects this will have on the quality of

NIOSH research.

As in the case of OSHA, the ideal would be to

know what the situation would have been in the

absence of NIOSH activities. Certainly some research and information dissemination would have

taken place at universities and in the private sector, even without Government activity. Although

it is difficult to quantify this, it is unlikely that

private sector parties by themselves would have

devoted the same level of resources to health and

safety research as the Federal Government has

through NIOSH. Because information is, to some

extent, a “public good, ” private parties have only

a limited incentive to develop it on their own.

Once published, many can benefit, but because

the information is already public, the original

researcher would encounter great difficulty in

charging each beneficiary for that information.

Thus, it can be argued, the Government needs to

be involved in order to provide this “public good.”

NIOSH is the only Federal agency dedicated to

occupational health and safety research and

dissemination. Although NIOSH is not the only

organization that conducts or sponsors epidemiologic and toxicologic studies of workplace hazards, its studies have advanced knowledge in this

field. Controls are developed in the private sector, but NIOSH has provided many of the detailed

sampling and analytical methods used by private

sector industrial hygienists. NIOSH publications

are widely distributed and serve as an important

source of reference on occupational hazards and

controls. Today, most newly graduated occupational health and safety professionals in the United

States are educated in programs that receive funding from NIOSH, and many come from the programs at the institutions that have been designated

as Educational Resource Centers.

Threshold Limit Values published by ACGIH in

1968. ACGIH has increased the number of substances on its list to over 600 and has revised the

TLVs for many substances from the 1968 list.

Since 1971, NIOSH has formally transmitted rec-
Ch. 13—Assessment of OSHA and NIOSH Activities . 271

ommendations concerning over 160 different substances, classes of substances, or hazardous working conditions to OSHA, After adopting the initial

group of startup standards, OSHA has issued new

or revised Permissible Exposure Limits and other

requirements for 10 substances, and work practice, monitoring, and personal protection requirements for 14 other substances and one physical

agent. A detailed numerical comparison for a

group of 123 substances shows that, overall,

OSHA standards are less stringent than NIOSH

and ACGIH recommendations.

The impacts of OSHA and NIOSH are hard to

evaluate. Accurate estimation of the costs of

OSHA regulation is difficult for a number of reasons. The most comprehensive cost estimates derive from a survey conducted by McGraw-Hill.

According to this survey, the share of capital

spending devoted to employee health and safety

has changed little in the last 5 years, remaining

at a percentage substantially below the levels of

the 1970s.

Assessing OSHA’s impacts on injury rates and

exposure levels is also difficult. The research on

OSHA effects on injury rates divides into two

groups—studies that find a statistically significant,

but small effect, and those that do not find any

significant effects. The limited research on exposure levels appears to show positive effects for

hazards that were the subjects of new or revised

OSHA regulations during the 1970s—vinyl chloride, asbestos, cotton dust, and lead.

Because NIOSH’s major activity is research, its

impacts are even more difficult to quantify. The

quality of NIOSH research has been criticized although NIOSH has recently taken steps for improvement. A number of other aspects of its operations have been criticized as well. However,

many occupational health and safety professionals

have graduated from NIOSH-sponsored training

programs. NIOSH has also been an important

source for the dissemination of information in this

field.

One final impact of both OSHA and NIOSH

is that their presence has served to increase the

attention given to occupational health and safety*

by workers, employers, and health and safety professionals. This increased attention facilitates the

identification of hazards and the development of

controls. Thus, indirectly, OSHA and NIOSH

activities have spurred improvements in worker

health and safety, although these effects probably

cannot be quantified.
14.

Decisionmaking for Occupational Safety

and Health: The Uses and

Limits of Analysis
Contents

General Issues in Decisionmaking . . . . . . . .

Private Decisionmaking . . . . . . . . . . . . . . .

Public Decisionmaking. . . . . . . . . . . . . . . .

Decision Tools and Rules . . . . . . . . . . . . .

OSHA Decisionmaking on Standards . . . . .

Principles Embodied in the OSH Act . . .

Regulatory Relief. . . . . . . . . . . . . . . . . . . . .

OSHA Standard-Setting. . . . . . . . . . . . . . .

Current OSHA Criteria . . . . . . . . . . . . . . .

Effects of Decision Rules . . . . . . . . . . . . . .

The Uses and Limits of Economic Analysis

Value of Economic Analysis . . . . . . . . . . .

Difficulties in Implementation . . . . . . . . .

Ethical Considerations . . . . . . . . . . . . . . . .

summary . . . . . . . . . . . . . . . . . . . . . . . . ● . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . .., . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Table No.

14-1. Willingness-to-Pay Estimates

TABLE

of the Value of Life . . . . . . . . . . . . . . . . . . . . ,

Page

275

276

276

277

278

278

279

2$1

289

2$9

2$9

292

293

Page

291
14 ■

Decisionmaking for Occupational

Safety and Health: The Uses and

Limits of Analysis

A number of different criteria are used for judg- This chapter discusses some general issues coning the desirability of changes that might improve cerning decisionmaking for occupational safety

workers’ health and safety. Some have proposed and health, the history of the use of economic

that greater reliance be placed on the use of cost- analysis by the Occupational Safety and Health

benefit analysis, cost-effectiveness analysis, and Administration (OSHA), and the merits and

other techniques of economic analysis for deci- limitations of the techniques of formal analysis.

sions concerning workplace health and safety.

GENERAL ISSUES IN DECISIONMAKING

The process of improving occupational safety

and health involves the identification of hazards,

the development of control techniques, and the

decision to control. Choices need to be made concerning products and workplace design by many

actors—the engineers in charge of design, the

managers who make decisions concerning production, and public officials with responsibilities for

protecting the health and safety of workers and

the public.

The decisions we need to make. . . turn on the

question: Which hazards are acceptable, which

not, in what amounts, and why?, . . And who

should be empowered to make this decision? (281)

In many cases, the answers to these questions

are not simple. Oftentimes facts are uncertain and

in dispute. Sometimes, values and ideals conflict

with each other. To resolve such disputes, societies rely on various institutional arrangements.

In the field of occupational health and safety in

the United States, the principal institutions are

Congress, the courts, the Occupational Safety and

Health Review Commission, and OSHA itself.

This issue of decisionmaking—the question of

who is authorized to make decisions and on what

basis—is important because the participants can

differ greatly on the nature of occupational

hazards and the best means to reduce or eliminate them. Labor, on the one hand, believes that

employers have often not done enough to reduce

or eliminate workplace hazards and desires a

strong governmental presence in setting and enforcing standards. Employers, on the other hand,

are often concerned about investing money in unnecessary controls, believing either that their

workplaces are not hazardous or that effective,

but less costly control methods are available. They

also often contend that they, as employers, should

be permitted to decide on appropriate control

methods, without the involvement of Government

agencies or labor unions.

Some disputes about the Government’s role in

occupational health and safety concern very technical questions about the application of the principles of industrial hygiene and safety engineering; some are debates at the very frontiers of

scientific knowledge on the mechanisms of toxicity. But beyond these disputes are more general

debates concerning the criteria on which decisions

will be made and who shall be empowered to

make them. The proposed resolutions of these

issues are based on interpretations of technical information about risk as well as the moral and ethical values, the political beliefs, and the immediate economic interests of the various parties

275
276 ● Preventing Illness and Injury In the Workplace

involved. In fact, one prominant feature of

disputes on occupational health and safety is that

debates over technical questions are often combined with discussions of more general issues of

policy, ethics, and social values.

To develop and present the information needed

for a fully informed decision on workplace hazards, various observers have suggested different

kinds of formal analysis. The techniques are, in

many cases, connected with proposals to specify

the criteria on which decisions must be based.

These criteria range from a vague injunction to

consider “all relevant effects” to requirements that

controls can be required only when “the benefits

exceed the costs. ”

Private Decisionmaking

On what basis do employers make decisions

concerning worker health and safety? What decision rules will they follow? Some employers, of

course, take actions to protect the health and

safety of their employees either out of altruism

or enlightened self-interest. But in general decisions made by employers follow the dictates of

the competitive market system in which they

operate.

Economists have developed models to explain

this market-oriented behavior. The simplest and

most commonly used model seeks to explain the

actions of firms in terms of profit-maximization

and cost-minimization. If this is a company’s goal,

it will take an action only if the expected revenue is at least equal to the costs of that action.

Using the technical language of economics, this

means that the firm will produce only up to the

point at which the marginal revenue from the last

additional product unit is equal to the marginal

costs of that unit.

Applied to investments and expenditures for occupational safety and health, this model predicts

that to prevent an occupational injury or illness,

employers will spend only as much as they can

expect to gain in terms of reduced workers’ compensation costs, improved employee productivity,

reduced “down time, ” etc. Thus, any investment

for health and safety must be justified in terms

of the short-term and long-term financial benefits to the firm. If the company is attempting to

be as profitable as possible, it will not take actions to protect employee health and safety solely

because health and safety are important goals, but

only when there are financial benefits to the firm.

If the firm does not follow this rule, it may find

itself spending money to improve health and safety without receiving any corresponding financial

benefit. Competitors that do not also make such

improvements will be able to produce the same

products at lower cost and then increase sales

and/or profits at the expense of the firm that invested in health and safety.

Health and safety professionals have often cited

the slogan “Safety Pays” as a justification for improving occupational health and safety. Although

in many cases this is true, in other cases it is not.

Moreover, even when it does pay, it generally

pays only up to a point.

Therefore some businesses will not always take

voluntary actions because they will not reap any

advantage over their competitors. One benefit of

Government regulation is that it puts all firms on

an equal footing. A company can undertake investments in employee health and safety without

fear that it will lose money to competing firms

that do not do so. Expressed differently, Government regulations may require certain measures

beyond those that “pay” from the point of view

of the individual firm (245).

This is not to say that all employers will ignore

occupational safety and health. Indeed, there are

numerous examples of employers and their professional staffs who have taken extensive actions

to improve worker health and safety, even without pressure from a Government agency. This

could be because of the commitment of professionals and companies to goals of ethical behavior

or corporate altruism; a decision by the firm to

pursue goals other than maximizing profits; or the

belief by company officials that such investments,

although not profitable in the short term, will

ultimately be to the long-term benefit of the firm.

(See additional discussion on voluntary activities

in ch. 15. )

Public Decisionmaking

During the congressional debates concerning

the Occupational Safety and Health (OSH) Act,
Ch. 14—Decisionmaking for Occupation/ Safety and Health: The Uses and Limits of Analysis 277

.

Photo credit Department of Labor, Historical Office

Rescue workers attempt to extricate a trapped worker

many references were made both to the rights of

American workers to safe and healthful working

conditions and to the high cost of work-related

illnesses and injuries. Congress concluded that too

many illnesses and injuries were occurring and

that the efforts being made and the institutions

of that day were not sufficient to achieve the goal

of preventing disease and injury in the workplace.

Broadly speaking, two different types of reasoning have been suggested to justify Government

intervention. The first is based on ethical arguments, MacCarthy (277) describes four different

ethical justifications for Government action that

are based on utilitarianism, workers’ rights, distributive justice, and public values. Others argue

that Government intervention must be justified

by economic criteria. In particular, the Government should intervene only in cases of “market

failure” and only after balancing costs and benefits of its decisions (425,446,463,685). Three

sources of “market failure” are particularly important for worker health and safety: inadequate

information, lack of labor mobility and unequal

bargaining power, and the presence of externalized costs.

Decision Tools and Rules

The techniques of cost-benefit and costeffectiveness analysis have been developed to

assist private and public decisionmakers. In previous assessments concerning medical technology,

OTA has considered cost-effectiveness analysis

and cost-benefit analysis as parts of a family of

related techniques (539). Both are designed to

compare the costs and effects of projects or alternative projects. The principal difference between

them is that in a cost-benefit analysis, both costs

and benefits are expressed by the same measure,

which is nearly always monetary. In cost-effectiveness analysis, on the other hand, costs and

benefits are expressed by different measures. Costs

are usually expressed in dollars, but benefits or

effectiveness are ordinarily expressed in terms

such as “years of life saved, ” “days of morbidity

or disability avoided, ” or other relevant measures ●

(539).

Cost-benefit techniques became widely used in

the United States in the 1930s and 1940s for the

evaluation of public works projects (in particular, for analyzing investments of public capital in

projects for irrigation, hydroelectric power, and

flood control). The Flood Control Act of 1936 explicitly called for a cost-benefit decision rule by

permitting the Government to finance a water

project only when “the benefits to whomsoever

they may accrue are in excess of the estimated

costs” (280). In the 1960s and 1970s, the techniques of cost-benefit and cost-efectiveness analysis were applied in formal budget planning systems in the Federal Government. To some extent,

these techniques have also been applied to questions of health policy (539).

Analysis can be a tool to assist in the decisionmaking process or it can be used as a formal decision rule. As a tool, the collection of information

and its analysis can assist policymakers to reach

sound, well-informed, reasoned decisions about

the management of workplace hazards. There is

widespread agreement, at least in principle, that

decisionmakers need to have some minimal understanding of the important features of the problem to be addressed, the factors involved in the

decision, and the implications of various courses

of action. There are, of course, disagreements concerning the application of this principle. In particular, there are often disputes about how much

information needs to be collected and to what extent policymakers should be allowed to act on the

basis of uncertain and incomplete information.
278 ● Preventing Illness and Injury in the Workplace

As a decision rule, however, formal analysis

is considerably more controversial. A decision

rule specifies the criteria on which decisions must

be based and usually requires that certain findings be made before action is permitted. For instance, a cost-benefit decision rule would be to

“select the alternative that produces the greatest

net benefit” (463).

As a tool, a cost-benefit analysis of a proposed

action can be provided to a decisionmaker, who

can still decide to undertake the proposed action

even if the analysis shows that the quantified costs

exceed the quantified benefits. The decision could

reflect a concern for the distributional consequences of a failure to act or consideration of

some important benefits of the action that could

not be quantified. Thus a cost-benefit analysis

provides information, but the decisionmaker still

has the flexibility to act even when the “bottom

line” of the analysis says, “Don’t act.” If a formal cost-benefit decision rule were in effect, the

decisionmaker would not be able to include those

other considerations in the final decision, but

could only act on the basis of the quantified comparison of costs and benefits.

As a decision-assisting tool, cost-effectiveness

analysis can be used to describe many of the consequences of an action. But because the costs (in

dollars) and the benefits (e.g., in lives saved) are

left in incomparable units, cost-effectiveness analysis will provide a clear decision rule only in two

circumstances. If a health goal is specified, then

a decision rule based on cost-effectiveness analysis will mandate the selection of the least costly

alternative that achieves that goal. Alternatively,

if a budget or expenditure is fixed, then a costeffectiveness rule will require selecting the alternative with the greatest health benefit.

In occupational health and safety, two other

types of analysis have become important—risk

assessment and feasibility analysis. What these imply for OSHA, however, has been the subject of

considerable dispute. The meaning of these terms

and requirements concerning their use by OSHA

have evolved over the last 14 years.

OSHA DECISIONMAKING ON STANDARDS

Principles Embodied in the OSH Act

When the OSH Act was passed in 1970, Congress clearly decided to involve the Federal Government in research and regulatory activity. In

particular, Congress mandated the adoption of

health and safety standards and set forth a mechanism for writing new standards. To some extent,

the law removed decisions concerning health and

safety from the competitive marketplace by limiting employer discretion. Congress, however, was

less clear about the precise decision rules that

OSHA would have to follow when setting these

standards.

At the beginning of the OSH Act, Congress

declared a purpose for Government activity in the

occupational health and safety field: “to assure

so far as possible every working man and woman

in the Nation safe and healthful working conditions.” The act empowered the newly created

agency to set and enforce mandatory occupational

health and safety standards. Section 6 laid forth

the procedures for adopting these standards: public notice of proposed actions, an opportunity for

public comment, the conduct of a public hearing

if requested, and a final decision based on the evidence presented to the agency. (Further details

about these procedures are given in ch. 12. )

Two subsections of the Act define health and

safety standards and specify the criteria on which

standards are to be based. Section 3(8) of the Act

provides:

The term “occupational safety and health

standard” means a standard which requires conditions, or the adoption or use of one or more

practices, means, methods, operations, or processes, reasonably necessary or appropriate to provide safe or healthful employment and places of

employment.
.

Ch. 14–Decisionmaking for Occupational Safety and Health: The Uses and Limits of Analysis .279

Section 6(b)(5) specifies the criteria for standards

concerning toxic materials or harmful physical

agents:

The Secretary . . . shall set the standard which

most adequately assures, to the extent feasible,

on the basis of the best available evidence, that

no employee will suffer material impairment of

health or functional capacity even if such employee has regular exposure to the hazard . . . for the

period of his working life. . . . In addition to the

highest degree of health and safety protection for

the employee, other considerations shall be the

latest available scientific data in the field, the feasibility of the standards, and experience gained

under this and other health and safety laws (emphasis added).

The extent to which the goals of environmental,

consumer, and worker protection are to be balanced against the costs of protection has defined

much of the debate on regulatory policy during

the last decade. Discussions of the standard-setting

authority of OSHA and the proper role for cost

considerations have focused on these two subsections.

The legislative history of the OSH Act that is

relevant to this question is, in the words of the

Supreme Court, “concealedly not crystal clear. ”

In particular, it does not explain what the Congress meant by “feasibility” or how OSHA was

to balance economic and technological considerations in setting standards. Neither the original Senate bill nor the House version included specific

provisions about regulating toxic substances; in

both, the section was added in committee.

The criterion of “feasibility” was first proposed

by Senator Jacob Javits (R-NY), who was concerned that the other bills then under consideration “might be interpreted to require absolute

health and safety in all cases.” The final amendments that resulted in section 6(b)(5) were added

on the Senate floor. They reflect the objections

to that section from several Senators. Senator

Peter Dominick (R-CO) argued, in particular, that

“[i]t is unrealistic to attempt. . . to establish a

utopia free from any hazards. ” After some discussion, a compromise was reached (280). The

language adopted by the Senate was later accepted

by the House-Senate Conference Committee and

incorporated in the final bill signed by President

Nixon.

There is no evidence that cost-benefit analysis

was ever explicitly proposed during those debates

as a decision rule for the new agency. Congress

had previously issued laws that did contain costbenefit decision rules, starting with the flood control legislation of the 1930s. The nonuse of such

a rule in the OSH Act, if not its explicit consideration and rejection, was important in the Supreme

Court’s decisions concerning the decisionmaking

authority of OSHA (discussed below).

MacLean (280) suggests that one possible reason that cost-benefit analysis did not enter the

debates is that it simply did not occur to Congress

that such an analysis could be applied to balance

health risks against economic costs. At that time—

1970—the theory and techniques of cost-benefit

analysis, which had been used to evaluate public

works projects, were still being developed for application to health and safety issues.

Because of concern about the costs of the OSH

Act, language was added to require that OSHA

take into account the “feasibility” of its standards.

But the final bill also included the goal that “no

employee will suffer material impairment. ” In the

floor debate, Senator Ray Yarborough (D-TX) expressed the sentiment behind this language: “We

are talking about people’s lives, not the indifference of some cost accountants. ” As commentators have noted, since the passage of the OSH

Act “the degree to which the complete protection

of safety and health should be compromised by

the technological difficulty and economic cost of

achieving that protection has been an issue of constant controversy” (51).

Regulatory Relief

In the early to mid-1970s, policymakers began

to face the simultaneous problems of price inflation and unemployment. Added to these was the

growing perception, which was not always based

on empirical analysis, that the Government’s

health, safety, and environmental regulations

were at least partially to blame for these economic

ills. (For discussions of more general issues in Federal regulation and regulatory reform, see 3,72,

133. )

A series of Executive Orders and other procedural requirements reflected this new perception
280 ● Preventing Illness and Injury in the Workplace

and placed new requirements on the regulatory

agencies. In 1971, the Office of Management and

Budget (OMB) issued a memorandum to all heads

of departments and agencies to improve interagency coordination concerning standards and

guidelines for environmental quality, consumer

protection, and occupational and public health

and safety. Known as the Quality of Life Review

Program, it covered, in theory, any agency action that would significantly affect other agencies,

impose costs on “non-Federal sectors, ” or increase

the need for Federal funds. Agencies were ordered

to submit to OMB schedules of future activities

and prepublication copies of proposed and final

actions. In addition, proposed and final regulations were to be accompanied by a summary that

indicated the principal objectives of the rules,

alternatives that had been considered, “a comparison of the expected benefits or accomplishments and the costs . . . associated with the alternatives considered, ” and the reasons for picking

the selected alternative (424).

Although this program was theoretically applicable to all regulatory agencies, in practice only

activities of the Environmental Protection Agency

were examined by OMB (158,401). The memo

had little effect on the activities of OSHA (47).

President Ford issued the first formal Executive

Order (E.O. 11821) on regulatory relief on November 27, 1974, as part of his “Whip Inflation Now”

program. This order required all major rules or

regulations issued by executive branch agencies

to be accompanied by “a statement which certifies

that the inflationary impact of the proposals has

been evaluated” (176). These were called “Inflationary Impact Statements, ” probably after the

“Environmental Impact Statements, ” required by

the National Environmental Policy Act.

A Presidential “oversight process” concerning

Federal Government regulatory activity was also

established at this time (659). A new agency, the

Council on Wage and Price Stability (CWPS), was

established in the Executive Office of the President to monitor the inflationary implications of

private sector wages and prices. CWPS was also

authorized to monitor the inflationary impact of

Federal regulatory activity, to review the Inflationary Impact Statements prepared by the regulatory agencies, and to participate in agency

rulemaking proceedings “in order to present its

views as to the inflationary impact that might result” (659).

The text of Executive Order 11821 did not specifically refer to cost-benefit analysis. However,

in its review of regulatory activities, CWPS

defined as “inflationary” those regulations for

which the costs exceeded the benefits (304).

Just before leaving office, President Ford extended his Executive Order, without any significant change in substance, with E.O. 11949, issued

on December 31, 1976. The name of the required

statements, however, was changed to “Economic

Impact Statements” (177).

President Carter issued his own Executive Order on the topic of regulatory procedures (E.O.

12044, March 23, 1978; renewed by E.O. 12221,

June 27, 1980), which bore the title “Improving

Government Regulations. ” The name of the required statements was changed to “Regulatory

Analyses” and in them the agencies were to present:

. . . a succinct statement of the problem; a description of the major alternative ways of dealing with the problem that were considered by the

agency; an analysis of the economic consequences

of each of these alternatives and a detailed explanation of the reasons for choosing one alternative over the others.

Regulatory Analyses were required for any regulation that would have an “annual effect on the

economy of $100 million or more” or a “major

increase in costs or prices for individual industries, levels of government or geographic regions”

(98,99).

The primary thrust of E.O. 12044 was to improve the content of Government regulations and

to encourage agencies to compare alternative approaches. Cost-benefit analysis was viewed as a

tool “to compare alternative approaches to a given

goal; . . . not to evaluate the goal, itself” (157,

170). The CWPS continued to prepare analyses

of agency regulations. The Carter administration

also created two other organizations: the Regulatory Council to compile calendars of future regulatory actions and to encourage innovative reg-
Ch. 14—Decisionmaking for Occupational Safety and Health: The Uses and Limits of Analysis ● 281

ulatory techniques, and the Regulatory Analysis

Review Group to review particularly important

regulations (157).

President Reagan issued E.O. 12291 on February 19, 1981, as a central component of his campaign for “regulatory relief.” Once again, the analysis requirement was renamed, this time to

“Regulatory Impact Analysis” (382). Unlike the

previous orders, however, which had only required the agencies to evaluate the economic impacts of their decisions, E.O. 12291 set an explicit

cost-benefit decision rule: “Regulatory action shall

not be taken unless the potential benefits to society

for the regulation outweigh the potential costs. ”

This Executive Order further specifies that “regulatory objectives shall be chosen to maximize the

net benefits to society” and requires, to the extent possible, that all benefits and costs be quantified in monetary terms, Thus, E.O. 12291 was

the first to require explicitly that regulatory decisions be based on a comparison of quantified costs

and benefits.

In addition, the Reagan administration centralized regulatory review in one agency -OMB—

and required agencies to submit to OMB copies

of proposed and final regulations and the accompanying Regulatory Impact Analysis in advance

of publication. Although the legal authority for

proposing and issuing regulations still remains

with the heads of the regulatory agencies, in practice the requirement for submission to OMB has

meant that the agency must receive approval from

OMB prior to publication. A Presidential Task

Force on Regulatory Relief, chaired by the Vice

President, was also established to resolve disputes

between OMB and regulatory agencies.

Congress has also added procedural requirements for Federal regulatory agencies. In September 1980, the Regulatory Flexibility Act (Public

Law 96-354) was enacted. It requires agencies to

prepare “regulatory flexibility analyses” for regulations that would have a “significant economic

impact on a substantial number of small entities”

(defined as small businesses, small nonprofit organizations, and small governmental jurisdictions).

In December 1980, Congress enacted the Paperwork Reduction Act (Public Law 96-511). In general, the purpose of this act was to reduce the

“burden” of federally required paperwork. OSHA

and other Federal agencies are required to obtain

the approval of OMB before conducting research

or issuing regulations that require the “collection

of information .“ This includes survey questionnaires and written report forms as well as requirements for record keeping. In addition, Congress

has considered, but has not enacted, a number

of bills that would require Federal agencies to conduct risk assessments and cost-benefit analyses

and that would change other regulatory procedures.

OSHA Standard-Setting

OSHA standard-setting activity has been a

source of disputes between management and labor, between advocates of stringent regulation

and those desiring regulatory relief, and between

those proposing the use of cost-benefit analysis

and those who reject any consideration of economic effects. Important to understanding those

disputes is the legislative history of the OSH Act,

the attitudes of business and labor, and the attitudes of the health and safety professionals who

staff OSHA and the National Institute for Occupational Safety and Health. The disputes concernning OSHA standards have often been settled in

the courts.

During its first decade, OSHA was criticized

by business representatives for failing to take account of the costs of complying with its standards and for not ensuring that those costs bore

a “reasonable relationship” to the benefits of the

standards. Labor representatives, on the other

hand, criticized OSHA for including compliance

costs as a factor in its decisions.

The values of OSHA personnel have been described as “pro-protection” and, it has been

argued, derive from the professional training and

background of the health and safety professions

and from their view of the agency’s mission. Most

OSHA staff have worked or been educated in the

occupational health and safety professions. As one

observer noted, “they believe strongly that workers ought to be protected from hazards and that

larger reductions of risk are preferable to smaller

ones (without much thought of cost). ” These val-
282 Preventing Illness and Injury in the Workplace

ues led the agency to tend to adopt “the more protective of alternatives presented to them by the

parties (from outside the agency] or by credible

scientific research” (245).

The agency did, however, recognize the need

to collect information concerning the technical

feasibility and estimated costs of its regulatory

proposals. From as early as OSHA’s first year

(1971), the agency has endeavored to develop this

information using a combination of in-house staff

and outside consultants. The goal of this early

activity was not to perform cost-benefit analyses,

but to provide feasibility and cost-of-compliance

estimates to counter the cost estimates and claims

of infeasibility made by the opponents of particular regulations (47).

The first major dispute concerning the use of

economic criteria involved a more stringent standard for asbestos exposure, which was issued in

1972. At that time OSHA lowered the permissible exposure limit for asbestos from 12 fibers per

cubic centimeter to 5, with a further lowering to

2 fibers per cubic centimeter by 1976. The delayed

effective date for the 2-fiber limit was designed

“to allow employers to make the needed changes

for coming into compliance.” OSHA was sued by

the Industrial Union Department of the AFL-CIO

for, among other issues, having considered economic factors in setting this limit. The Industrial

Union Department argued that the phrase “to the

extent feasible” in section 6(b)(5) should be interpreted to mean only technological feasibility—

i.e. whether or not the technology to control exposures was available.

The D.C. Court of Appeals ruled in this case

that OSHA could take account of the costs of

complying with a new standard. Thus, in this

decision, “feasibility” under the OSH Act was

defined to include both technology and economics. According to the court, a standard would be

considered economically feasible if compliance

with it would not threaten the viability of an industry as a whole, even if individual firms might

close because they could not meet the standard

(223).

Two subsequent decisions refined this twopronged definition of feasibility. The AFL-CIO

challenged OSHA’s decision to relax a regulation

concerning the guarding of mechanical power

presses (“no hands in dies”). In this case, the Third

Circuit Court of Appeals ruled that while the OSH

Act was a “technology forcing piece of legislation,” OSHA’s determination that the standard

was technologically infeasible was adequately supported. In addition, this court, following the reasoning of the earlier asbestos decision, ruled that

OSHA could consider “economic consequences”

when setting standards. In particular, OSHA

could not “disregard the possibility of massive

economic dislocation caused by an unreasonable

standard” (1).

Secondly, in an industry challenge to OSHA’s

regulation of vinyl chloride, the Second Circuit

Court of Appeals upheld a “technology-forcing”

standard. By this decision, a standard could be

considered feasible even if the technology necessary for compliance was not already widespread

in the regulated industry. All that was necessary

was that the technology was “looming on today’s

horizon” and could be brought into widespread

use. A standard would be considered technologically infeasible only if meeting the standard was

shown to be “clearly impossible” (454a).

. . . the Secretary is not restricted by the status

quo. He may raise standards which require. . .

improvements in existing technologies or which

require the development of new technology.

At about the same time as these judicial decisions, President Ford issued the first Executive Order requiring inflationary impact statements. In

following years, OSHA came under pressure from

the Council on Wage and Price Stability to base

its decisions on the results of cost-benefit analysis. A proposed standard concerning coke oven

emissions was the basis for the first clash between

OSHA and CWPS. CWPS participated in the

rulemaking proceeding and argued that OSHA

had overstated the expected benefits of the proposed standard. Using its own estimates of the expected number of lives saved and two estimates

of the “value of life” from the economics literature,

the Council suggested that the proposed standard was not worthwhile. Finally, CWPS recommended that OSHA consider allowing the use of

respirators to comply with the standard (290).

Between the time of proposal and of final promulgation, a new Assistant Secretary for OSHA,
Ch. 14—Decisionmaking for Occupational Safety and Health: The Uses and Limits of Analysis ● 283

Morton Corn, was appointed. About the use of

cost-benefit analysis he has written (122):

After arriving at OSHA, I engaged in an indepth consideration of cost-benefit analysis, applying the methodology to the coke-oven standard. . . .With the dose-response data at our disposal, various assumptions were used to ring in

changes on different methodologies for estimating benefits. The range in values arrived at, based

on the different assumptions, was so wide as to

be virtually useless. The conclusion I reached after

this exercise was that the methodology of costbenefit analysis for disease and death effects is

very preliminary, and one can almost derive any

desired answer.

In October 1976, when OSHA actually issued

its regulation concerning coke oven emissions, its

statement of reasons clearly rejected the use of

cost-benefit analysis. In part, this position was a

reaction to the arguments of CWPS, whose intervention was perceived as an attempt to reduce the

level of worker protection. In the preamble to the

final regulation, OSHA based its rejection of costbenefit analysis on the difficulties of accurately

estimating the expected benefits of the new standard and the lack of “an adequate methodology

to quantify the value of a life” (620).

This attitude toward cost-benefit analysis continued during the Carter administration. In 1977,

Eula Bingham, as Assistant Secretary for OSHA,

expressed concern about proposed procedures

concerning economic impact analysis (56):

While one can argue over the specific role of

economics in establishing regulations, it is clear

to me that economics should not be a paramount

consideration in setting safety and health standards. The overriding purpose of the OSH Act is

to protect workers, tempered by considerations

of feasibility, Accordingly, I would agree that

some economic impact analysis should be performed to provide a basis for evaluating industry representations as to economic impacts and

possibly to influence the length of the compliance

period allowed for a given standard. I do not

believe that policy decisions impacting worker

safety and health can or should be subject to a

formalized benefit-cost test.

CWPS continued to participate in OSHA’s

standard-setting proceedings and generally was

very critical of OSHA’s proposals. In a widely

publicized case, Charles Schultze (then chairman

of the Council of Economic Advisers), his staff,

and CWPS became involved in the cotton dust

rulemaking process in 1978. They suggested

changes in OSHA’s draft standard. After an appeal to President Carter, the major requirements

for engineering controls in the standard were not

changed, although some features of the standard

were modified. The intervention by Schultze and

CWPS, however, was viewed by many as an attempt to reduce the cost and the protectiveness

of that regulation (135,290,479).

In 1978, OSHA issued final standards for benzene, DBCP, arsenic, cotton dust, acrylonitrile,

and lead. Four of these six final standards were

challenged in the courts. The cases concerning the

benzene and cotton dust standards are particularly relevant to the evolution of the use of economic analysis at OSHA.

OSHA’s more stringent standard for occupational exposure to benzene was challenged by the

petroleum industry. The Court of Appeals for the

Fifth Circuit ruled in this case that the phrase “reasonably necessary or appropriate” contained in

the definitional section of the act (section 3(8))

meant that OSHA could issue a more stringent

regulation only if it estimated the risks addressed

by the standard and determined that the benefits

of the standard bore a “reasonable relationship”

to the costs. This ruling, in effect, erected a costbenefit decision rule for the agency to follow. The

court invalidated the standard because it concluded that there was insufficient evidence that

this more stringent standard would have any “discernible benefits” (13).

This decision was appealed to the Supreme

Court, which in the summer of 1980 upheld the

lower court’s decision to vacate the standard, although it did not follow the same reasoning. In

fact, while the Court voted 5 to 4 to strike down

the standard, the majority could not agree on a

common set of reasons. Five separate opinions

were issued by the Court, but no single opinion

had the support of more than four justices. Justice Stevens presented the views of four of the

justices who had voted to strike down the standard. In that opinion, the issue of whether the OSH

Act required the agency to follow a cost-benefit
z&f . Preventing Illness and Injury in the Workplace

rule was not addressed. Instead, this plurality

declared that the agency had not made a “threshold finding” that risk presented by benzene exposure was “significant” (224):

By empowering the Secretary [of Labor] to promulgate standards that are “reasonably necessary

or appropriate to provide safe or healthful employment and places of employment,” the Act implies that, before promulgating any standards, the

Secretary must make a finding that the workplaces in question are not safe. But “safe” is not

the equivalent of “risk-free.”. . . a workplace can

hardly be considered “unsafe” unless it threatens

the workers with a significant risk of harm.

Therefore, before he can promulgate any permanent health or safety standard, the Secretary

is required to make a threshold finding that a

place of employment is unsafe-in the sense that

significant risks are present and can be eliminated

or lessened by a change in practices.

After an extensive review of the record in this

case, the plurality ruled that because OSHA had

not made this threshold finding and because the

record before the agency did not contain “substantial evidence” to support such a finding,

OSHA had exceeded its authority in issuing the

more stringent standard for benzene exposure.

The Court did not rule on the issue of whether

the OSH Act required a cost-benefit test in addition to this requirement to demonstrate “significant risk.”

The Court provided only limited guidance as

to what was meant by “significant risk, ” words

that do not actually appear in the language of the

act. To quote the plurality opinion (224):

First, the requirement that a “significant” risk

be identified is not a mathematical straitjacket.

It is the agency’s responsibility to determine. . .

what it considers to be a “significant” risk. Some

risks are plainly acceptable and others are plainly

unacceptable. If, for example, the odds are one

in a billion that a person will die from cancer by

taking a drink of chlorinated water, the risk

clearly could not be considered significant. On the

other hand, if the odds are one in a thousand that

regular inhalation of gasoline vapors that are two

percent benzene will be fatal, a reasonable person might well consider the risk significant and

take appropriate steps to decrease or eliminate it.

Although the agency has no duty to calculate the

exact probability of harm, it does have an obligation to find that a significant risk is present

before it can characterize a place of employment

as “unsafe. ”

In a footnote, the Court noted that the ultimate

decisions of the Agency concerning the acceptable

level of risk “must necessarily be based on considerations of policy as well as empirically verifiable facts” (224).

Justice Marshall filed a dissenting opinion for

the four Justices who voted to uphold OSHA’s

benzene standard. In that opinion, Marshall argued that the plurality’s review of the record was

“extraordinarily arrogant and extraordinarily unfair” because the plurality had improperly made

its own findings concerning factual issues and had

unfairly described OSHA’s analysis of these

issues. Moreover, this dissent argued that the requirement to demonstrate a “significant risk” was

“a fabrication bearing no connection with the acts

or intentions of Congress and is based only on

the plurality’s solicitude for the welfare of regulated industries” (224).

The issue of whether the OSH Act required a

cost-benefit test in addition to a finding of significant risk was taken up in a case concerning a

more stringent standard for exposure to cotton

dust. Textile industry representatives argued that

OSHA had exceeded its statutory authority because it had neither conducted a cost-benefit analysis nor explictly determined that the benefits of

the standard justified the costs of compliance. Labor representatives and OSHA argued that the

OSH Act did not require such a cost-benefit decision rule. Instead, after determining that exposure

to cotton dust presented a “significant risk” (as

required by the decision in the benzene case), the

agency was required to issue the most protective

standard subject only to the constraint that compliance with the standard be technologically and

economically feasible.

The Supreme Court affirmed the OSHA cotton dust standard by a vote of 5 to 3. The majority opinion held that cost-benefit analysis was not

required by the OSH Act. Instead, Congress had

erected a requirement for “feasibility analysis. ”

Citing dictionary definitions that “feasible” means

“capable of being done, ” the Court ruled (17) that

section 6(b)(5) of the OSH Act
Ch. 14—Decisionmaking for Occupational Safety and Health: The Uses and Limits of Analysis ● 285

. . . directs the Secretary to issue the standard

that “most adequately assures. . . that no employee will suffer material impairment of health, ” limited only by the extent to which this is “capable

of being done. ” In effect. . . Congress itself

defined the basic relationship between costs and

benefits, by placing the “benefit” of worker health

above all other considerations save those making

attainment of the “benefit” unachievable. Any

standard based on a balancing of costs and benefits by the Secretary that strikes a different balance than that struck by Congress would be inconsistent with the command set forth in sec.

6(b)(5).

In a footnote, the Supreme Court also endorsed

the definition of economic feasibility that had been

suggested by OSHA. According to this, to prove

a standard economically feasible, OSHA must

show “that the industry will maintain long-term

profitability and competitiveness” (17). This definition is consistent with the earlier courts of appeal rulings on the standards for asbestos, coke

oven emissions, and lead (10,223,654).

The legal battles concerning OSHA standards

were not just about the details of economic analysis and risk assessment. In part, these battles took

on symbolic meanings. That is, people on both

sides of these issues took positions based on what

they believed these cases symbolized for Government regulatory activity. Some supported the

standards issued by OSHA because these standards were believed to represent strong efforts to

control occupational health and safety problems

after decades of neglect. They viewed cost-benefit

analysis as a technique that was being introduced

to weaken governmental protections. Others opposed these standards and supported legal restrictions on OSHA, including requirements for costbenefit analysis, because they believed that the

agency had gone too far in imposing regulatory

costs on businesses.1

‘Table A-3 in appendix A presents a list of the legal cases concerning OSHA standards. For further discussion of OSHA’s legal

obligations concerning the development of standards, see (333,408).

Mintz (307) provides excerpts from primary source documents related to this history of standard-setting, including legal briefs and

court opinions.

Current OSHA Criteria

OSHA now uses a four-step process for making decisions about health standards, as expressed

by former Assistant Secretary Thorne Auchter.

First, the agency determines that the hazard in

question poses a “significant risk.” Second, OSHA

determines that regulatory action can reduce this

risk. Third, it sets the regulatory goal (for health

standards, this is the permissible exposure limit)

based on reducing this risk “to the extent feasible.” Finally, OSHA conducts a cost-effectiveness

analysis of various options to determine which

will achieve this chosen goal in the least costly

manner (434,638).

However, it is not clear what criteria apply to

safety standards and other regulations issued by

OSHA. In the cotton dust decision, the Supreme

Court left this issue unresolved, but did state that

it is possible that Congress could have set different

criteria for health standards than for safety standards. It also noted that the “reasonably necessary

or appropriate” language of section 3(8) would

apply to safety standards (224).

“Significant risk”

To determine whether a hazard poses a “significant risk of material health impairment, ”

OSHA now generally uses the techniques of quantitative risk assessment. In several publications

since the Supreme Court decisions concerning

benzene and cotton dust, OSHA has presented

quantitative risk assessments, These risk assessments have calculated the estimated risk at the

currently permitted exposure levels and the anticipated risk at the new, lowered exposure levels,

in order to show that its proposed standards are

addressing “significant risks” and that they will

serve to reduce the risk of occupational disease.

As discussed above, the Supreme Court provided only limited guidance on what occupational

risks should be considered significant. The plurality opinion appears to have indicated that a l-in1,000 risk of death is “significant” while a onein-one-billion risk is not. However, the example

in this opinion refers to a one-in-one-billion risk

from a single drink of water and a l-in-1,000 risk

from regular inhalation of gasoline vapors. If this
286 ● Preventing Illness and Injury in the Workplace

is adjusted for the total amount of water the average person consumes, the resulting risk estimates

for these hypothetical examples concerning inhalation of gasoline and consumption of chlorinated

water are about the same. (McGarity has reached

a similar conclusion by calculating the total number of cases expected in the exposed populations

for these two examples (297a).)

OSHA’s “significant risk” determinations have

principally relied on comparing the estimated risks

for a particular hazard to the I-in-l, (X)() guideline. For additional support, OSHA has also included comparisons with the risks of fatal occupational injury (derived from the data of the BLS

Annual Survey) and with the quantified risks of

several occupational health hazards. For example, OSHA has argued that a particular level of

arsenic exposure presents a “significant risk” because the estimated death rate at that level (8

deaths per 1,000 workers) is

. . . 1/4 to 1/2 the death rate [from injuries] in

the riskiest occupations, 2 to 5 times higher than

the risks in occupations of average risk, and 10

to 100 times the risk of the low risk occupations.

It is also 1/3 of the maximum permitted radiation cancer risk but about 3 times higher than the

cancer risk which 95 percent of radiation workers are under (638).

Finally, OSHA has compared the estimated risks

of exposure at currently permissible levels to the

estimated risks for exposure that were regulated

in previous years. For instance, in proposals concerning new standards for ethylene dibromide and

asbestos, OSHA compared the estimated risks for

those substances to the risks of exposures to cotton dust and coke oven emissions (642,647).

In one case, OSHA has exempted one group

of employers from the OSHA commercial diving

standard because the agency determined that the

estimated risks of injuries for this group were

below those for industries with low injury rates.

In explaining its decision, OSHA relied on a calculation showing that the injury rate for scientific and educational divers was lower than the

injury rates for a number of industries, including

banking (634).2

‘This calculated injury rate was based on the number of reported

deaths and injuries divided by 2,OOO hours per year, the equivalent

of full-time employment, 40 hours per week for so weeks per year.

Feasibility

As indicated earlier, for both technological and

economic feasibility the general requirement is

that OSHA must show that compliance with the

new standard is possible, that it is “capable of being done.” Technological feasibility refers to the

availability of technologies and methods to comply with the new standard. To prove this, OSHA

can, of course, refer to plants and technologies

that already meet the new standard. But OSHA

is not bound just to the status quo. The courts

have ruled that the agency has the authority to

require technological improvements. The agency

must present substantial evidence to prove that

it is reasonable to expect that efforts by industry

will lead to compliance, even if the exposure reductions are greater than those that have previously been achieved. In the words of one court

(654),

OSHA’s duty is to show that modern technology has at least conceived some industrial strategies which are likely to be capable of meeting the

PEL [permissible exposure limit] and which the

industries are generally capable of adopting.

To meet this duty, OSHA uses the information

provided in public comments and the public hearings. A feasibility determination usually relies on

the reports and opinions of expert consultants, the

availability of control technologies, descriptions

of plants and companies already achieving the

new standard, and general comments submitted

to OSHA.

Economic feasibility refers to the economic capability of the regulated industries to afford the

technologies needed for control. The Supreme

Court has ruled that an analysis of economic feasibility does not mean cost-benefit analysis.

Rather, OSHA is required to show that compliance with a standard is affordable by the regulated industry us a whole. A standard can be considered feasible even if it adversely affects profits

and causes some employers to go out of business

This calculation, howwer, substantially understates the risk during diving operations because none of these employees is actually

underwater for 2,000 hours per year. In fact, the actual underwater

exposure time for these divers is usually less than one-tenth of the

time assumed by OSHA (249a). The actual risk estimates for this

group of employees while engaged in diving would, therefore, be

over 10 times greater than the risk shown by the OSHA calculation.
Ch, 14—Decisionmaking for Occupational Safety and Health: The Uses and Limits of Analysis . 287

rather than comply with the standard. However,

OSHA must show that the long-term profitability and competitiveness of an industry will be

maintained.

To analyze economic feasibility, OSHA generally estimates the costs of compliance for a

standard. These compliance costs are usually presented in several ways: for example, average cost

per affected firm, average cost per exposed

worker, compliance costs as a percentage of industry sales, and compliance costs as a percentage of total payroll costs. OSHA has not set forth

any mathematical formula for determining when

these costs would be considered economically infeasible. Rather, it presents the costs, and expresses a judgment about whether or not they

would impose a substantial burden or have a significant impact on the market structure of the affected industries.

Cost-Effectiveness Analysis

Finally, OSHA uses the techniques of costeffectiveness analysis to evaluate alternative methods of achieving the health protection goal that

has been selected on the basis of the risk and feasibility analyses. Cost-effectiveness analysis at this

point is applied in a relatively narrow way. It is

not used to judge the “worth” or desirability of

the standard, but only to select among alternative approaches for meeting that standard.

Regulatory Impact Analyses

Executive Order 12291, issued in early 1981, requires that OSHA prepare Regulatory Impact

Analyses. These consist of detailed discussions of

the quantified benefits, compliance costs, and economic impacts for alternative standards considered by OSHA.

The order also requires that all OSHA regulatory actions be reviewed by OMB, which, to the

extent permitted by law, requires regulatory agencies to demonstrate that their regulations are costbeneficial. Generally, the results of the OMB review and agency responses need not be made public. Thus, it is difficult to determine if OSHA decisions have been altered by OMB’s cost-benefit

review (510). It has been argued that OMB and

the Presidential Task Force on Regulatory Relief

have improperly influenced at least two OSHA

regulatory proceedings, concerning hazardous

communication and commercial diving, after private meetings with representatives of the industries affected by the regulations (519,520).

In several cases concerning proposed standards,

OSHA has published alternatives suggested by

OMB. These include, for example, the 1981 proposal for hearing conservation (637) and the 1984

proposal on grain elevators, which included

OMB-suggested alternatives (348). Two disputes

between OMB and OSHA concerning proposed

standards have been appealed to the Presidential

Task Force on Regulatory Relief. In both cases

(the cotton dust and hazard communication standards), OSHA was allowed to publish its proposals

(637).

OMB suggestions have been incorporated in at

least two final standards. For the hearing conservation amendment, several technical requirements

were altered (637). In another case concerning a

final standard for ethylene oxide exposure, OMB

expressed “reservations” about part of the OSHAdrafted standard (in particular, the provision establishing a short-term exposure limit). In response, OSHA removed that provision from the

final, published standard, and requested additional public comment (649). OSHA considers

OMB review to be “akin to internal review,” after

which all final decisions are made by OSHA and

the Department of Labor (637).

The General Accounting Office has studied

agency compliance with Executive Orders 12044

and 12291 and has collected information on the

costs of preparing economic analyses. For ON-IA,

these analyses cost an average of $338,000 (510).

Although it is difficult to determine the value and

effects of these analyses, the amount of resources

used by OSHA to develop them has been substantial.

Effects of Decision Rules

Questions remain, however, concerning the actual application of the current OSHA criteria.

How large does a risk need to be in order to be

considered significant? How is risk to be measured? How is technological feasibility determined?
288 . Preventing Illness and Injury in the Workplace

How costly can a standard be before it threatens

the viability of an industry and thus is considered

economically infeasible (277)? Indeed, there have

been and continue to be disputes about the application of any set of decision criteria by a regulatory agency. In practice, decision criteria may

only define a range of allowable decisions and will

often not mandate a particular result.

The positions adopted by the participants in

OSHA’s regulatory proceedings, general political

considerations, and the personal judgments of

OSHA’s Assistant Secretaries and its staff have

been and continue to be important to OSHA’s

decisionmaking. Moreover, OSHA has always

balanced various factors before issuing standards.

For instance, OSHA stated in its preamble to the

vinyl chloride regulation that its “judgments have

required a balancing process, in which the overriding consideration has been the protection of

employees.” These more informal judgments may

be even more important than the formal decision

rules used by an agency.

In addition, the court battles about OSHA decisions and more general discussions of “regulatory

reform” were not only about what the decision

rules should be, but also about who should be empowered to interpret and apply those rules.

Should the Assistant Secretary for OSHA have

the authority to make these decisions with only

limited review by the courts? Or should reviewing judges become extensively involved in analyzing the factual record and OSHA’s judgments?

And to what extent should outside agencies, such

as CWPS and OMB, be involved in examining

and approving OSHA’s decisions?

Because judgment and the identity of the decisionmaker are important, and because there are

many uncertainties in estimating effects (discussed

below), the adoption of a cost-benefit rule may

not lead to decisions that are different from those

adopted under a feasibility test. DeMuth (136) has

suggested that “just as the Corps of Engineers became adept at demonstrating that every dam that

could be built would pay for itself, so the regulatory agencies will learn to demonstrate, with increasing analytical verve, that every new regulation is cost-beneficial. ”

Would OSHA’s decisions have been different

under a cost-benefit decision rule? One contract

report (262) prepared for this assessment suggests

that for at least some of the major OSHA health

standards, the use of a cost-benefit decision rule

would have led to less stringent standards.

Judith and Lester Lave (262) applied several different decision frameworks to four health standards issued by OSHA--those for coke oven emissions, benzene, vinyl chloride, and cotton dust.

They compared the regulations actually issued by

OSHA using its criteria of technological and economic feasibility and those that the Laves believe

would have been issued under a cost-benefit decision rule. In three of these cases-for coke oven

emissions, benzene, and vinyl chloride-a costbenefit analysis would have led to a less stringent

regulation. For cotton dust, the conclusion of an

analysis is very dependent on the discount rate

chosen and the value placed on preventing additional cases of byssinosis (see below for a discussion of these issues). This case, they concluded,

is one in which “reasonable analysts can choose

values within the range accepted by the economics profession and wind up with opposite conclusions about the desirability of a stringent standard.”

The conclusions about the fates of the vinyl

chloride and cotton dust standards are noteworthy because in both cases improvements in

productivity accompanied compliance with a

stringent OSHA standard. In part, those improvements may have been spurred by the necessity to

comply with OSHA’s stringent requirements. If

a cost-benefit decision rule had been in effect for

OSHA, these gains in employee health and in economic productivity might not have occurred.

It cannot be conclusively shown that the application of a cost-benefit decision rule would

have changed OSHA’s decisions and the nature

of technological change in affected industries.

Lave and Lave had to rely on currently available

information. Had a cost-benefit rule been in effect, OSHA might have prepared additional quantitative information, especially on the benefits of

its standards.

However, their conclusion does support the

concern of many participants and observers that
Ch. 14—Decisionmaking for Occupational Safety and Health: The Uses and Limits of Analysis ● 289

cost-benefit analysis in practice would not be a

neutral decision rule, but one that is biased

against improvements in worker health and safety

(43,65,115,194,411). For example, Baram (43) has

concluded that in many cases “[c]ost-benefit analysis is a ‘numbers game’ that is used to oppose

regulatory actions that have been proposed to

protect public health and the environment .“ Connerton and MacCarthy (115) believe that the use

THE

Value

of cost-benefit analysis will prevent regulatory

agencies from carrying out their responsibilities

to protect health and safety and will lead to extensive delays in an already slow regulatory process— in other words, to a “paralysis by analysis. ”

Boden (65) has expressed concern that under current circumstances, the use of cost-benefit analysis “may bias political decisions against even those

regulatory decisions that are cost-effective. ”

USES AND LIMITS OF ECONOMIC ANALYSIS

of Economic Analysis

Economic analysis—including cost-benefit analysis, cost-effectiveness analysis, and the feasibility analysis performed by OSHA—can provide

decisionmakers with important information on

the problems and alternatives they face and the

consequences of various courses of action. In “The

Implications of Cost-Effectiveness Analysis of

Medical Technology” (539), OTA described 10

general principles of analysis that are applicable

to the conduct of both cost-effectiveness and costbenefit analyses. These principles are:

●

●

●

●

●

●

●

●

●

●

Define problem.

State objectives.

Identify alternatives.

Analyze benefits and effects.

Analyze costs.

Differentiate perspective of analysis.

Perform discounting.

Analyze uncertainties.

Address ethical issues.

Interpret results.

Following these principles can lead to the development of clear and useful analyses. But the process of collecting information, ordering it, and

analyzing it can be just as important as the final

results of an analysis.

Performing an analysis of costs and benefits can

be very helpful to decisionmakers because the

process of analysis gives structure to the problem,

allows an open consideration of all relevant effects of a decision, and forces the explicit treatment of key assumptions (539).

Lave and Lave (262) have suggested that the use

of economic analysis “sharpens the questions,

clarifies the implications of policies, and generally manages to attain solutions at lower cost. ”

In addition, when the necessary data are available and when the quantification of intangible effects is not a problem, cost-benefit analysis can

shed light on the implications for economic efficiency of alternative projects.

As one element of the decisionmaking process,

as a decision-assisting tool, economic analysis can

provide guidance and information. In addition,

economic analysis can provide support for decisions or actions that may be taken on other

grounds. For example, in some cases, decisions

based on noneconomic grounds will also be supported by the results of economic analysis. In

those cases, most people would support the use

of economic analysis. Arguments arise when the

analysis supports less stringent standards than

those chosen for other reasons.

Difficulties in Implementation

The limitations of these techniques are particularly evident when they are considered as decision rules. In 1980, OTA concluded that cost-effectiveness and cost-benefit analyses exhibited too

many methodological and other limitations to

justify sole or even primary reliance on them in

making decisions (539). That conclusion is still

applicable for the analysis of measures to improve

occupational safety and health.

A number of the analytical principles-defining

the problem, stating objectives, identifying alter-
290 . Preventing Illness and Injury in the Workplace

natives, differentiating the perspective of the analysis, analyzing uncertainties, and interpreting

results—are relatively uncontroversial, in large

part because they are components of any process of rational decisionmaking. However, the

quantification of benefits and costs and application of a discount rate to them are distinctive

features of these types of analyses. They are also

the features that present the most difficult methodological issues and arouse the most controversy, especially when applied to governmental

regulation of worker health and safety.

Benefits Analysis

The benefits of various alternatives must be

identified, and if possible, quantified. Quantification bears the danger that the effects that can be

measured will receive more attention than those

that are not quantified, even if the unquantified

are believed to be more important. Lave (263) has

called this a “Gresham’s law of decisionmaking. ”

On this danger, Mishan has written (308):

. . . the outcome of all too many cost-benefit

studies follows that of the classic recipe for making horse and rabbit stew on a strictly 50-50 basis,

one horse to one rabbit. No matter how carefully

the scientific rabbit is chosen, the flavor of the

resulting stew is sure to be swamped by the horseflesh. The horse, needless to say, represents those

other [unquantified] considerations . . . .

The uncertainties of any quantification of benefits begins with uncertainties concerning the relationship between exposures and health hazards.

Epidemiologic studies are often limited by small

sample sizes, a lack of information on past exposures, and the presence of confounding variables. The results of animal testing present problems in determining the applicability to human

populations and in extrapolating from the high

doses often used in such studies to the lower doses

found in the workplace (see ch. 3 and 542).

Even after identifying the risks involved, an

analysis of the benefits of controlling them must

discuss the effectiveness of the various technologies that could be applied. Often, information

crucial to that analysis is lacking. For example,

personal protective equipment is often suggested

as a cost-effective alternative to engineering controls, but there is only limited information available on the actual workplace effectiveness of such

devices (ch. 8).

After identifying and quantifying the benefits

to be expected from a given action, a cost-benefit

analysis (but not a cost-effectiveness analysis) requires that these be converted to units that can

be directly compared with the costs of the action.

Analysts almost invariably choose monetary units

for this.

There are two major approaches to placing a

value or a price on human lives or lifesaving programs. The first is to consider the value of a life

to be the present discounted value of the person’s

future income. Because this method, known as the

human capital approach, assumes that the value

of a person’s life is equal to their expected income,

it implies that “women are valued less than men,

blacks less than whites, retired people less than

workers, and low-paid textile workers less than

higher-paid steel workers” (115). In addition, it

cannot include the value that other people attach

to saving a particular person’s life.

The other major approach has been to evaluate

lifesaving programs on what people are “willing

to pay” for them. This approach, too, runs into

problems. It is difficult to find out exactly what

people are “willing to pay.” A survey could be

used, but the interpretation of the results is difficult.

Another measure can be obtained from analysis of the additional pay that workers may receive

for taking unsafe jobs. (These have been termed

hazard premiums or compensating wage differentials. See ch. 15 for a discussion. ) It is also possible that consumers are willing to pay “extra” for

less hazardous consumer products. Some economists, using the techniques of statistical analysis, have attempted to measure the extent of these

“revealed preferences. ” These studies are subject

to a number of technical problems in the measurement of risk levels and in adjusting for other

factors that influence wages and prices. The results

of these studies have been used to calculate the

“value of a life. ”

Table 14-1 shows the wide range of implied

values for human lifesaving derived from such
. ——

Ch. 14—Decisionmaking for Occupational Safety and Health: The Uses and Limits of Analysis ● 291

Table 14-1 .—Willingness-to-Pay Estimates of the

Value of Lifea

Value per

statistical life

(thousands of

Method 1977 dollars)b

Survey approach:

Acton (1973) . . . . . . . . . . . . . . . . . . . . 38

Jones-Lee (1976) . . . . . . . . . . . . . . . . 8,440

Landefeld (1979) . . . . . . . . . . . . . . . . 1,200

Revealed preference:

Labor market:

Dillingham (1979) . . . . . . . . . . . . . . . 277

Thaler and Rosen (1975) . . . . . . . . . 364

Viscusi (1978) . . . . . . . . . . . . . . . . . . 1,650

Smith (1976) . . . . . . . . . . . . . . . . . . . . 2,045

Olson (1981) . . . . . . . . . . . . . . . . . . . . 5,935

Consumption activity:

Dardis (1980) . . . . . . . . . . . . . . . . . . . 101c

Ghosh, Lees, and Seal (1975) . . . . . 260

Blomqist (1979) . . . . . . . . . . . . . . . . . 342

Portney (1981) . . . . . . . . . . . . . . . . . . 355

%/here a study included a “central” or “most reasonable” estimate, that is shown,

where only a range was ~iven, the lowest value is presented

bvalue~ were convefled t. 1977 dollars using the U S Bureau of Labor Statistics

Consumer Price Index

cit IS unclear from the Dardis study what year’s dollars apply, although the

estimate presented here appears to be based on an average value for the period

1974-79

SOURCE. (262)

studies. Two different types of studies are cited.

The first, labeled the survey approach, involves

surveying groups of people and asking them what

they think should be spent on lifesaving programs.

The second type, revealed preference, uses data

concerning either work and employment (labor

market) or consumer purchasing (consumption activity) to calculate either workers’ or consumers’

“willingness to pay” for risk reduction.

The wide range in these values creates difficulties for analysts attempting to use the “willingness

to pay” approach to place a value on the benefits

of programs. Besides this practical problem of

choosing a figure for valuing benefits, there are

also several conceptual problems with using the

“willingness to pay” approach to assess lifesaving programs. (See 277 and 297 for a discussion. )

Recently a third approach has been suggested

(259). Called “adjusted willingness to pay,” it attempts to combine the two traditional approaches

by estimating what an individual should be willing to pay to avoid the financial losses associated

with premature death. However, it still is not able

to include the willingness of family, friends, coworkers, and strangers to contribute to lifesaving programs. Moreover, the value of life derived

from this approach remains a function of income

and wealth.

Cost Analysis

The estimation of costs is often thought to present fewer difficulties than the analysis of benefits. Nevertheless, the costs of controls are often

hard to estimate accurately. In part this is because

many control technologies involve changes in the

actual productive process or have multiple uses.

For example, what portion of the costs of installing duct work in a new plant should be attributed

to the need to dilute an air contaminant? And

what percentage should be listed as the cost of

providing heating and air conditioning to a

plant—an ordinary cost of doing business?

In addition, company officials are usually in the

best position to know what needs to be changed

in their plants to comply with a proposed standard. But these people also have a vested interest

in the regulatory proceeding. Moreover, line managers and plant engineers would rather overstate

than understate expected costs in order to ensure

that they will be given a sufficient budget within

the company to pay for the controls (140). Finally,

when OSHA “forces” the diffusion of technology,

there is little or no experience on which to estimate the costs of widespread use of a particular

new technology. Consequently, the costs of proposed regulations are often overestimated. (For

examples of this, see 195. )

Uncertainties

Estimates of both costs and benefits are usually surrounded by uncertainty. The combined effect of these uncertainties and of assumptions

made by the cost-benefit analyst, both of which

are found at every stage of the estimation of costs

and benefits, can produce large differences in the

analyses conducted by different people. Thus it

is possible for one analyst to take a high estimate

of costs and a low estimate of benefits and conclude that the program should not be undertaken,

while another analyst can take a lower cost estimate and higher estimate of the benefits and conclude that the program is worthwhile. Often these

disputes cannot be resolved. (For a discussion of

several kinds of uncertainty, see 175. )
292 ● Preventing Illness and Injury in the Workplace

Discounting

Finally, these analyses require that costs and

benefits be made commensurate over time. This

usually involves adjusting future costs and benefits at a specified discount rate to calculate the present value of the costs and benefits. The general

justification for discounting derives from the fact

that resources can be invested to earn interest over

time. Thus, in order to compare costs and benefits that occur in different years, all future effects

are discounted and expressed in terms of “present

values. ”

In practice, there is considerable disagreement

over what discount rate should be used (539).

Moreover, although the logic of discounting is

derived from several basic propositions of economic theory, the discounting of future costs and

benefits has two effects that create some

controversy.

First, the effects (both costs and benefits) on

future generations are almost completely ignored

with most discount rates. Second, the process of

discounting implies that risks that manifest themselves in the very near future are to be prevented

before risks 10, 15, or 20 years in the future. This

means that, all other things being equal, the risks

of occupational injury should be reduced before

reducing the risks of occupational cancer. Or, for

example, that OSHA should act to reduce the risks

of exposure to beta-naphthylamine (which has

caused cancer in some workers after a latent

period of less than 5 years) before it acts to reduce the risks of exposure to asbestos (which

causes various types of cancer with latent periods ranging from 15 to 30 years).

Distributional Effects

Although cost-benefit and cost-effectiveness

analyses were designed to evaluate economic efficiency, they are not very well developed for the

evaluation of distributional implications. This is

an important problem for the application of these

techniques to programs designed to improve occupational health and safety. Usually these programs are aimed at benefiting a group of workers, while the costs of the programs fall largely

on employers. In addition, the benefit to the

workers often involves the prevention of irreversible damage to their health or well-being while

the costs to employers involve increased expenses

and, possibly, reduced profits. This further complicates the comparison of costs and benefits.

Alternatives to Aggregated Analysis

Some analysts believe that ultimately solutions

to these problems can be found. OTA (539) has

suggested that the alternative of “arraying” the

various effects of a program or proposal should

be investigated, rather than trying to reduce all

effects to a single “bottom line. ” Ashford, et al.

(33), for example, have suggested “trade-off analysis.” This approach would involve a comprehensive description of the expected effects of an

agency’s actions on three “flows”: economic, environment/health, and legal. To avoid the problems of monetization and valuation, all effects are

left in their natural units. To reduce discounting

problems, the time pattern of the effects is presented. Finally, the analysis provides a matrix of

effects and actors, to present a clear picture of who

gains or loses what from the regulatory action.

Ethical Considerations

The use of cost-benefit and cost-effectiveness

analyses also raises ethical considerations. Supporters of the greater use of these techniques point

to the limited resources available for improving

health and safety. This, they believe, implies that

the only moral course of action is to use those resources in a way that maximizes net social benefit. As a moral doctrine, this belief derives from

the traditions of utilitarianism (246). The advocates of cost-benefit analysis believe that the

use of formal analysis will help achieve the greatest possible level of human welfare (304,446).

. . . estimating benefits and costs is often difficult, especially . . . where the benefits may be

in terms of lives saved or pain and suffering

avoided. Some say this means putting a value on

human pain, suffering, and death, which is not

only ludicrous, but downright immoral. If anything, we would argue, the reverse is true. Since

resources are limited, we cannot avoid the need

to identify—and, in some way, to estimate-benefits and costs. The more compassion we have for

our fellow human beings, the more important this

becomes (304).
— .—

Ch. 14—Decisionmaking for Occupational Safety and Health: The Uses and Limits of Analysis 293

In disagreement, MacLean and Sagoff (281) discuss the philosophical justifications used to support

cost-benefit decisionmaking and conclude that

these justifications fail. Cost-benefit analysis is

not, in their view, a neutral decisionmaking rule

because it is unable to take account of many commonly held ethical principles and values. In order to include concerns for equity and justice, a

formal cost-benefit analysis would either have to

find some way to assign a price to these concerns

or ignore them. But justice and equity are not

merely matters of consumer preference; they depend on political and moral arguments: “Equity

is a matter of right or wrong; it is to be thought

over and argued about. It is not a consumer service or a fungible good” (281).

On examining the cost-benefit decision rule presented in President Reagan’s Executive Order

12291, MacLean and Sagoff conclude that its

unitary yardstick of positive net benefits is

SUMMARY

Improving occupational safety and health involves the identification of hazards, the development of control techniques, and the decision to

control. The issue of decisionmaking—the question of who is to make decisions and on what

basis—is important because interested parties can

differ greatly about the nature of occupational

hazards and the best means to reduce or eliminate them. Employers’ decisions tend to follow

the dictates of the competitive market system;

public decisions can consider a number of other

factors.

Various techniques of economic analysis including cost-benefit and cost-effectiveness analyses

have been developed to assist private and public

decisionmakers. As decision-assisting tools, these

techniques can help policymakers to reach sound,

well-informed, reasoned decisions about the

management of workplace hazards. There is widespread agreement, at least in principle, that decisionmakers need to have some minimal understanding of the important features of the problem

to be addressed, the factors involved in the decision, and the implications of various courses of

severely limited: How can cost-benefit analysis

claim to be either neutral or comprehensive if it

cannot deal with a wide range or moral, cultural,

aesthetic, and political concerns? There may be

some issues that raise few important cultural or

moral issues; for example, the commodities markets may be left to determine the prices of hog

bellies or potash. This does not show, however,

that markets or market analysis can give us an

adequate policy for public safety and health. On

the contrary, where moral, political, and cultural

values—not simply economic ones—are at stake,

we need to make moral, political, and aesthetic

judgments. Cost-benefit analysis does not replace

these “subjective” judgments with “objective” or

“neutral” ones. Rather, it distorts or ignores the

noneconomic values it cannot handle (281). (See

205,246,277, and 297 for additional discussion of

the ethical implications of cost-benefit analysis. )

action. As decision roles, however, formal analysis is considerably more controversial and significantly more limited in its uses.

In 1980, OTA concluded that cost-effectiveness

and cost-benefit analyses exhibited too many

methodological and other limitations to justify

sole or even primary reliance on them in making

decisions. That conclusion is still applicable for

the analysis of measures to improve occupational

safety and health.

These limitations include difficulties in quantifying the magnitude of the expected benefits, in

valuing these benefits, in calculating the expected

costs of improved health and safety, in performing discounting, and in analyzing the distributional implications of alternative policies. The use

of cost-benefit and cost-effectiveness analyses also

involves ethical considerations. The advocates of

cost-benefit analysis believe that the use of formal analysis will help achieve the greatest possible level of human welfare. Critics of formal analysis, however, argue that cost-benefit analysis is

limited because it is unable to take account of
294 Preventing Illness and Injury in the Workplace

many commonly held ethical principles and

values.

The history of decisionmaking at OSHA is intertwined with debates over the allowable use of

cost considerations. Some of that debate has been

over the specific requirements of the OSH Act and

whether OSHA must base its decisions on a costbenefit analysis. When it passed the OSH Act,

Congress brought the Federal Government into

the field of occupational health and safety. Congress, however, was less clear about the precise

decision rules for OSHA to follow when setting

health and safety standards. Because of the concern of a number of Congressmen about costs and

economic effects, OSHA was required to consider

the “feasibility” of its standards. But the final bill

also included the goal that “no employee will suffer material impairment . . . “ In addition, during the 1970s, a series of Executive Orders and

other procedural requirements have affected

OSHA’s standard-setting activities.

A number of legal challenges to OSHA standards have brought the courts into this arena. Two

of these challenges were decided by the Supreme

Court. The Supreme Court has ruled that the

OSH Act does not require that OSHA base its

decisions on the results of cost-benefit analyses;

instead the agency must base its decisions on determinations of “significant risk” and “feasibility. ”

OSHA now uses a four-step process for making decisions about health standards. First, the

agency determines that the hazard in question

poses a “significant risk.” Second, OSHA determines that regulatory action can reduce this risk.

Third, it sets the regulatory goal based on reducing this risk “to the extent feasible. ” Finally,

OSHA conducts a cost-effectiveness analysis of

various options to determine which will achieve

this chosen goal in the least costly manner.

OSHA also prepares Regulatory Impact Analyses to comply with the requirements of Executive

Order 12291. Because the results of the OMB review of these analyses are not made public, it is

difficult to determine if OSHA decisions have

been altered by OMB’s cost-benefit review. In addition, one contract report prepared for this

assessment suggests that for at least some of the

major OSHA health standards issued in the 1970s,

the use of a cost-benefit decision rule would have

led to less stringent standards.
15.

Incentives, Imperatives, and the

Decision to Control
Page

297 ‘

301

302

313

320

322

● ✎✌✎☛✎✎ ✎

✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎

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TABLE

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315

Safety Clauses,

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FIGURE

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● ● . ● ● ● ● ● ● ● ● ● 310 & Lawsuits 1970-82

.
15

Incentives, Imperatives, and the

Decision to Control

OTA has identified a number of incentives and

one major imperative for the implementation of

control technologies. As used here, an “incentive”

is something that encourages an employer to implement a control. Because of the special value

placed on health and safety, many people believe

that society should, by law and regulation, require

employers to take the steps necessary to prevent

work-related illnesses and injuries. This belief

underlies the basic approach of the Occupational

Safety and Health (OSH) Act of 1970, which is

an “imperative” for implementing controls.

A great deal that is known about controlling

the causes of occupational illness and injury has

not been applied in many of the Nation’s 4.5 million workplaces. Examining incentives and imperatives can assist in understanding the decisions

to implement controls and can outline areas for

improvement. Most incentives and imperatives

can be used together and, in some cases, they interact and build on each other. In some other

cases, however, various historical circumstances

have led to compromises that bar the use of some

incentives (e.g., workers’ compensation laws generally prohibit employees from suing their employers), This chapter presents a description and

assessment of these incentives and imperatives.

ASSESSMENT OF EXISTING INCENTIVES

Voluntary Efforts

After being informed of or discovering the existence of job hazards, some employers will take

action to reduce, minimize, or eliminate those

hazards. They do so either because of altruism

toward their workers or out of enlightened selfinterest. Strictly speaking, pure altruism implies

that the employers take these actions only because

of concern for their workers without thought of

the ultimate implications for the firm in terms of

worker good will, productivity, profits, or future

sales. Although this will often be true for the personal motivations of health and safety professionals, most decisions concerning company policy will consider carefully the potential effects on

profits.

Probably more common than pure altruism are

voluntary actions out of enlightened self-interest.

These actions are taken because a firm perceives

that voluntary efforts, although not necessarily

profitable in the short term, will benefit the firm

in the long run. This long-term benefit could be

Photo credit OffIce of Technology Assessment

Signs are often used to provide information to workers.

This one is a gentle reminder about the

use of safety shoes

an enhanced corporate image or the perception

that a given firm is a “good place to work. ” In

addition, voluntary efforts may be undertaken to

solve a particular problem before the Government

or other groups become involved. (Of course,

there may be other benefits to the firm in terms

297
298 Preventing Illness and Injury in the Workplace

of reduced workers’ compensation costs, reduced

capital costs if accidents damage plant and equipment, or a reduced threat of potential liability or

an Occupational Safety and Health Administration (OSHA) fine. )

The pressures of the competitive marketplace

will, however, substantially limit the ability of individual companies to improve employee health

and safety. As described in chapter 14, if a company spends resources on improving workplace

conditions and its competitors do not, this company can easily find itself at a disadvantage because its competitors can use the resources thus

saved to expand or improve production. Unless

the company can save money in some other way,

it will have lost money by attempting to do the

“right” thing.

There are several ways in which the company

may receive a financial return on its health and

safety investment—through reduced workers’

compensation premiums, for example, or an improved labor relations atmosphere, or reduced

vulnerability to fines for violating Government

regulations. In this case, the action is not exactly

“voluntary, ” but results from some other incentive.

Voluntary actions may result in a firm saving

on both the direct and indirect costs of occupational accidents. The direct costs include workers’ compensation payments for lost wages and

medical care, while the indirect costs include loss

of productivity, disrupted schedules, equipment

and property damage, administrative time for accident investigations, and training of replacements. Estimates of the size of indirect costs range

from 4 times to 20 times the direct costs of accidents (82,380). The National Safety Council has

estimated that the average total cost (both direct

and indirect) to an employer of a lost-workday

accident is about $9,400 (324). Sheridan (436)

reports that one large firm has estimated the total

direct and indirect cost to be $14,000 for a lostwork-time injury, $100,000 for a fatality, and

$200,000 for injuries involving permanent disability.

As noted in chapter 10, it has frequently been

said that the most important variable in determining whether a firm will be generally protective of

employee health and safety is the commitment of

top management. Two studies (441,443) have

found that low-accident-rate plants tended to have

“greater management commitment and involvement in plant safety matters” (443), although both

of these studies involved relatively small numbers

of companies. In addition, a number of companies, particularly large ones, have created departments to handle issues of occupational and

environmental health and safety, have hired professional staffs with technical expertise concerning health and safety, and have established internal review mechanisms to ensure compliance with

health and safety standards. (See 179 for a discussion of some of these arrangements, and box

P.)

The important role played by management

commitment to the goals of occupational safety

and health must be stressed. In the United States,

employers are responsible for the organization,

design, and management of workplaces. If improvements in employee health and safety are to

occur, they will have to involve decisions by management. It is therefore not surprising that management commitment has been called the single

most important ingredient in effective health and

safety programs.

The other incentives and imperatives described

in this chapter can be thought of as ways of obtaining the commitment of employers when voluntary efforts are insufficient to correct occupational health and safety hazards. These incentives

and imperatives generally reward or penalize companies. It has also been suggested that the compensation of individual line managers should be

linked to improvements in product safety, pollution control, and occupational health and safety

(139).

In addition, there are a number of voluntary

organizations and associations that have been active in the occupational safety and health field.

These include professional societies, voluntary

standards organizations, trade unions, and employer associations. Companies and their employees may participate in these voluntary organizations and these voluntary organizations are

sometimes involved in the development of some

of the other incentives and imperatives. This is
Ch. 15—incentives, imperatives, and the Decision to Control ● 299

Box P.—Example of Voluntary Control Efforts: Du Pont

Effective company-run safety and health organizations require strong impetus and initiative on the

part of management. At E. I. du Pont de Nemours and Co., this is reflected in the company’s “nine

safety principles” (described inch. 6). The commitment of Du Pont to worker safety dates to the 19th

century, when it produced gunpowder.

In the early days the company’s mills blew up so regularly that they were built with three sturdy stone

walls and one flimsy wooden wall, facing Brandywine Creek. When the inevitable explosion came, the wooden

wall would blow out. The rest of the mill would remain standing and could be economically restored to service. “Going across the creek” became a company euphemism for being blown to bits (284).

In fact, two du Pont family members were killed in these explosions.

Du Pont requires all levels of management and all employees to be responsible for health and safety

on the job. Not only does this attention improve employees’ working conditions, but whether dealing

with 19th century gunpowder or 20th century petrochemicals, this attention reduces the chances of destroying valuable plant and equipment and incurring expensive downtime. In addition, Du Pont integrates

safety with the management of the firm and uses the safety records of managers in making decisions

about promotions.

Du Pont established the Corporate Environmental Quality Committee in 1966 to carry out “top

management’s commitment to environmental quality, including safety and health.” It meets weekly and

is the overseer of four supporting committees, including an “Occupational Safety and Health Committee.”

At the plant level, Du Pont has Central Safety Committees consisting of plant staff managers and

assistant managers, the superintendent of safety and health, the environmental control manager, and

the plant physician or medical supervisor. This committee directs the plant safety and health program,

and meets at least once a month. Plant subcommittees, headed by first-line supervisors, vary in number

and function, depending on plant size and needs. Anywhere from 6 to 10 workers serve on subcommittees; there are no requirements, however, for minimum employee representation on the subcommittees.

Individual employees are selected by the plant manager to serve on subcommittees, which are considered the focal point for plant involvement in safety policy. Their findings are reported to the Central

Safety Committee.

About 95 percent of all safety hazards are corrected by line organization, and the resolution of individual safety hazards rarely requires involvement of a subcommittee. The minority of complaints that

are referred to the committee concern issues that potentially involve plant-wide policy changes.

It has been noted that because of its low injury rate, Du Pont annually saves millions of dollars

for workers’ compensation compared with what its costs would be if its injury rate equaled the national

average for all manufacturers (284). But the chemical industry as a whole, of which Du Pont is a part,

generally has had a lower injury rate than that for all manufacturers, although Du Pont’s injury rates

are better than even the chemical industry average. Little information is available on what it costs Du

Pont to achieve this savings in workers’ compensation costs.

Finally, while Du Pont is also a widely recognized leader in providing a comprehensive occupational health program for its employees, data on the incidence of occupational illnesses are limited (see

ch. 2). Thus it is impossible to quantify Du Pont’s occupational illness rates and compare them with

averages for the chemical industry or for all manufacturers.
300 Preventing Illness and Injury in the Workplace

especially true for OSHA regulatory proceedings,

in which both trade unions and employer associations are often extensively involved.

Voluntary Standards

These voluntary activities may include cooperative efforts to develop voluntary standards, industry standards, or consensus standards. However, comparatively few of these standards are

concerned with occupational health and safety.

Some voluntary standards are purely advisory;

others, because they specify certain product attributes or dimensions, are ignored by firms only

at their peril. For example, some voluntary standards specify the design and dimensions of nuts and

bolts. If a firm wishes to manufacture nuts to fit

the bolts of other manufacturers, the firm must

follow the “voluntary” standard. Another example would be the various standards concerning the

electronic components, such as stereo components

and computers. The use of voluntary standards

in these areas enables consumers to purchase several pieces of equipment from different manufacturers and then hook them together into a smoothly functioning system.

Still other “voluntary” standards have been

adopted by Government agencies and now have

the force of law. For example, the National Electrical Code, developed under the auspices of a

voluntary organization, the National Fire Protection Association, is widely used as the basis for

the mandatory building codes of many localities

(203). Similarly, most of the existing OSHA safety

standards, which now have the force of law behind them, began as “voluntary” standards developed under the auspices of the American National Standards Institute (ANSI). (See discussion

in ch. 12. )

The standard-writing work of technical organizations, professional organizations, and trade

associations is often delegated to subgroups or

committees. OTA has not precisely determined

what fractions of the participants in these voluntary standard-setting groups represent employers,

manufacturers, labor unions, public interest

groups, government, and others. It is clear, however, that labor and public interest groups have

been and continue to be underrepresented in the

deliberations of these committees. Small businesses may also be underrepresented.

There are several reasons for this. First, participation involves the commitment, at the very

least, of staff resources. Oftentimes, unions and

public interest groups lack sufficient staff resources to participate. Second, standard-setting

groups have generally been created and staffed

by manufacturers and employers, in part because

these groups began the process in order to standardize equipment and designs (the “nuts and bolts”

standards). Labor and public interest groups are

generally not interested in those issues and do not

participate. This historical nonparticipation may

have carried over into the safety and health standards activities. Third, the membership of the committees is often unbalanced. For example, the

committee that drafted the ANSI standard for

abrasive blasting operations consisted of 14 manufacturer and trade association representatives,

6 people from professional organizations, 5 representatives of government agencies, 3 individual members, and 1 person representing a labor

organization. Such unbalanced representation not

only provokes questions about the degree of protection afforded by voluntary standards, it also

makes labor and public interest groups hesitate

to participate for fear that their involvement will

imply approval of a voluntary standard that they

had only minimal influence on.

In addition, voluntary standards are just that,

“voluntary, “ and probably cannot be enforced.

Enforcement by a trade association or other organization may violate the antitrust laws. The Supreme Court has ruled that companies can exchange safety-related data and set standards to

protect the public’s health and safety or to protect themselves from product liability actions. The

Court has also cautioned, however, that the

standards must not be used as a guise for excluding competitors or for facilitating price fixing. The Federal Trade Commission, which shares

authority for the enforcement of antitrust laws

with the Justice Department, has advised that

compliance with such a standard must remain

voluntary. There appears to be a limited exception to this general rule-trade associations can

require members to abide by a standard that is

established to provide the legitimacy of something
Ch. 15—Incentives, Imperatives, and the Decision to Corftrol . 301

(e.g., a breed of cattle) or to establish a network

in which the rules or standards are fundamental

to its functioning (e.g., the arrangements surrounding the purchase of flowers by telephone)

(203).

It is not likely, therefore, that a trade association would try to enforce a health or safety standard by excluding an offending company from

membership, organizing a boycott, or taking some

other punitive action. It may make efforts to encourage companies to comply, but the possibility of running afoul of the antitrust laws will make

it stop short of requiring companies to comply

(203). Thus even if a company follows a recommendation concerning worker health and safety

made by a trade association or standards organization, the employer has no assurance that competitors will follow suit. (Voluntary standards also

play some role in liability actions and the enforcement of the “general duty” clause of the OSH Act

(203).)

Moreover, there is concern about the adequacy

of voluntary standards, even if they are fully

adhered to by employers. Beyond the common

lack of labor and public interest representation

on the committees that write these consensus

standards, some people object to the standards

because they often involve a compromise among

the various interests, which may reduce the level

of protection afforded by these standards. In addition, the employer and manufacturer representatives on these committees are likely to agree to

a standard that each of them can already adhere

to. They are unlikely to adopt a standard that

would require large changes in their current

operations, even if some industry leaders have

achieved higher levels of protection. Thus these

standards are likely to represent the “lowest common denominator” of performance within an industry.

Voluntary standards are an important source

of information for employers, workers, government agencies, and others involved in the health

and safety field. They represent hours of effort

by many practitioners and professionals in this

field and can often be useful sources of technical

information, especially for defining terms and

standardizing certain technical aspects of measurement and control.

Although they can be updated more quickly

than OSHA has tended to rewrite its regulations

(see ch. 12), unions and public interest groups

question whether voluntary standards are sufficiently protective. The existence of these standards might bring the practice of companies to a

common level, but, in general, voluntary standards and the voluntary approach will often lead

to only limited changes in the health and safety

conditions of the workplace.

Provision of Information

The availability of information about occupational hazards and their control is a necessary first

step for many improvements in workplace health

and safety. It may be provided by private sector

organizations, including professional societies,

voluntary standards organizations, insurance

companies, employers’ associations, trade unions,

universities, and individual experts. Or it may be

provided through the research and dissemination

efforts of Federal and State Governments. The

availability of information can combine with the

other incentives to prompt employer action. For

example, a company management committed to

improving job safety and health would use available information to analyze job conditions and

to make improvements. But without both commitment and information, no actions will be

undertaken.

The provision of information through research

and dissemination is an important activity unlikely to be met by private parties because information, once disclosed, becomes a “public good. ”

This means that the developer of the information

cannot capture its full economic benefit because

that person cannot always charge for the information. Furthermore, as illustrated by the description of a company’s use of computer conferencing (ch. 10), a company may elect to hold private

its safety and health information or to release it

only under its own terms.

State and local “right to know” laws, and the

development of an OSHA regulation concerning

“hazard communication” (labeling) promise to

provide more information to workers and employers. The impetus for three laws has been provided by coalitions of unions, health and safety
302 . Preventing Illness and Injury in the Workplace

professionals, and public interest groups who

believe that workers and their doctors have a right

to be informed of the identity of substances they

work with and the potential hazards of those substances. Economists have also suggested that one

way in which the existing market system may

have failed is by not providing workers with sufficient information about hazards. In either case,

one possibility is to require that information be

provided to workers (628).

The new OSHA “hazard communication” regulation requires, among other things, that containers of “hazardous” chemical substances bear

a label with information on the name of the substance and the precautions to be taken. Both the

laws and the OSHA regulation enhance the dissemination of information to individual workers

in expectation that this will lead to improvements

in on-the-job health and safety conditions. In addition, labels provide important information to

“down-stream” employers who previously had

been ignorant about hazards in the materials they

purchase.

One important issue in this area concerns manufacturers’ desire to limit the information provided in order to preserve trade secrets, such as

the chemical composition of a product. A second

issue concerns which substances are deemed “hazardous” and who determines this. A third concerns the coverage of the laws and regulations.

Do citizens and communities, in addition to workers, have access to this information? And what

industries are covered? Fourth, there are questions

about the relationship between the new OSHA

regulation and the State and local “right to know”

laws. In particular, Federal OSHA is arguing that,

in general, its “hazard communication” regulation

preempts State and local “right to know” laws.

All of these issues are being considered in the recent legal challenge to the OSHA regulation. (For

a general discussion of these issues, see 44. )

The increased availability of information on

workplace hazards may serve as an incentive for

companies to introduce controls. However, while

the provision of information through both research and dissemination is an important first

step, it is not sufficient by itself to guarantee improvements in health and safety. It may not counterbalance other factors that affect employers’

decisions about whether or not to implement controls (box Q), which may be more important than

a lack of information in explaining why many

employers have not invested in health and safety

improvements. (In addition, as described in ch.

12, the OSHA consultation program also provides

information on hazards and controls to employers. )

Workers’ Compensation and Insurance

Employers may take actions to improve job

safety in order to reduce the costs of workers’

compensation and property insurance. The most

important purpose of the workers’ compensation

system is to provide workers suffering from workplace injuries and illnesses with medical treatment
Ch. 15—Incentives, Imperatives, and the Decision to Control ● 303

and to compensate them for the income lost because of those injuries and illnesses. But the improvement of occupational safety and health is

also a goal of workers’ compensation. To the extent that employers, through this system, pay for

the costs of medical treatment and lost wages,

there is a monetary incentive to reduce those costs.

Thus, employers may install control technologies

in order to save on their workers’ compensation

premiums. In addition, the insurance companies

and the state agencies that provide workers’ compensation insurance often provide services to improve health and safety conditions in their client

companies.

Similarly, actions to reduce the costs of property insurance may coincidentally benefit worker

health and safety. For example, preventing fires

and explosions in a factory may result in lower

property insurance costs, as well as reducing the

number of workers injured.

The history of workers’ compensation reveals

different motives and goals for the various interested groups (described further in ch. 11). Progressive reformers sought to alleviate the loss of

income suffered by accident victims and their families and to encourage prevention. Businesses

wanted to stabilize the uncertainties inherent in

the liability system, to limit the growth in the size

of awards, and to restrict more sweeping social

changes. They were also interested in prevention,

in part as an additional means to control or reduce costs. The National Association of Manufacturers, for example, was very impressed with

the preventive effects of the German compensation system. In their view, the causes of accidents

needed to be given equal consideration with the

consequences (274). Nearly every contemporary

observer includes prevention as one of the goals

for workers’ compensation (30,46,106,131,317,

656,657),

Workers’ Compensation and

Occupational Injuries

Although many employers and insurance companies believe that workers’ compensation is an

incentive for prevention of occupational injuries,

the precise circumstances under which this is true

are fairly complex (see, e.g., 656,657). Moreover,

empirical evidence concerning the effect of this

incentive is thin.

There are, of course, difficulties in estimating

what injury rates would have been in the absence

of workers’ compensation. In theory, various statistical techniques can be used to analyze the effects of particular programs, after adjusting for

other factors that influence injury rates. One study

(105) found a decrease occurred in the number of

certain occupational fatalities at the same time

that workers’ compensation was created. Several

other studies (53,104,106,107), however, have not

found a favorable effect on injury rates from

workers’ compensation.

The economic incentive regarding occupational

injuries is diluted to some extent because many

employers pay premiums that are based on the

average experience for their industry or line of

business (so-called manual rates). These rates

apply, it was estimated in 1972, to the 85 percent

of companies that employ about 15 percent of the

work force (317). These firms are so small that

year-to-year injury rates vary widely purely by

chance. Thus, in order to ensure year-to-year certainty of payout by the insurance carriers, as well

as to minimize administrative costs, these companies are grouped and pay rates determined from

the manual.

At the other extreme are firms large enough to

predict with a high degree of confidence their accident rates from year to year. Except in States

that prohibit it, these firms generally insure themselves. It has been estimated that less than 1 percent of firms self-insure, but that those firms

employ 10 to 15 percent of the workers included

under the compensation system (317).

Finally, firms in the middle are “merit-rated,”

generally using either “experience-rating” or

“retrospective-rating,” which are methods for tying a firm’s premiums to its actual loss experience.

Under experience-rating, insurers modify the manual or class rate for a firm by its actual accident

experience for the most recent three years. Thus,

successful efforts to prevent injuries in the current year will lead to premium savings in the following three years. As the firm’s size increases,

more weight is given to the company’s actual experience and less to the employer’s class or indus-
304 Preventing Mess and Injury in the Workplace

try average (409,656). Under retrospective-rating,

the employer pays for losses up to specified ceiling limits and the insurer pays for losses above

the ceiling. Thus this plan “provides the firm with

a combination of insurance and self-insurance”

(656,657).

In addition, premium discounts are given to

large policyholders and some insurance companies

pay dividends to their policyholders (682). These

dividends can be either “flat rate” (the same to

all policyholders) or “sliding scale” (higher rates

paid to employers with better loss records and to

larger policyholders). The sliding scale plans, because they tie dividends to the loss experience of

firms, may provide safety incentives (657).

Although the rates for small companies are generally not directly based on their experience, if

such a firm has a particularly bad record it might

be placed in an “assigned risk pool,” with a correspondingly higher premium. Small firms with

very good records, however, generally do not receive a reduction in their premiums (317).

A primary goal of insurance is to spread risks

among employers, thus preventing, for a given

employer, a very large or catastrophic loss in any

one year. The losses to be paid out are made,

through insurance arrangements, into predictable and regular annual payments. Moreover,

when the pooling of risks places safe employers

in the same group with less safe employers and

both have the same premium rate, the less safe

will not have any incentive to improve performance. Thus, the goal of insurance or loss spreading

acts to dilute the incentive provided by workers’

compensation.

Although this effect has been often noted, the

degree of dilution is unclear because, although

most employers do not appear to be experiencerated, most employees work for employers who

are. Moreover, as Victor (656) has shown, the size

at which a firm becomes eligible for experience

rating varies dramatically among industries,

largely because of the differences in injury rates

among industries. Finally, although most employees work in firms that have some form of

experience-rating, it is difficult to determine what

portion of all occupational injuries and illnesses

occur in these firms.

There have been only a few empirical studies

of the effects of experience-rating on injury rates.

Russell (409) found that large firms, which are

generally experience-rated, had lower injury rates

than medium-sized firms. But she also found that

small firms had low injury rates as well, even

though they, as a group, are not experience-rated.

Two other published studies have not been able

to isolate any measurable effects for the experience-rating system used in workers’ compensation

(109,464).

A second limitation on the safety incentive provided by workers’ compensation is found in the

benefit levels. Employers’ incentives are directly

related to the degree that the workers’ compensation system provides for the full social costs of

injuries. Generally speaking, workers’ compensation pays the medical expenses associated with

the injury but only a portion of the employee’s

lost wages.

The States generally replace two-thirds of lost

wages up to a maximum amount or ceiling. This

replacement, however, is usually based on the employee’s wages just before the injury and are often

not adjusted for potential increases in the employee’s earnings over his or her career. In addition, many States have mandatory waiting periods or minimum lengths of time that a disability

must last before any payment will be made. Although workers’ compensation benefits are not

taxable, the system does not replace lost fringe

benefits, which have become an increasingly

larger portion of employee wage packages in the

last decade. Moreover, the ceiling on payments

is frequently so low that many workers receive

much less than the theoretical two-thirds replacement. It was estimated that during the late 1960s,

workers’ compensation had a median wage-replacement rate of only 50 percent (52). More recently,

a group of researchers found earnings-replacement

rates of 46 percent, 59 percent, and 75 percent in

California, Florida, and Wisconsin (81). But it is

not clear to what extent this applies to other

States.

Furthermore, as a general rule, workers’ compensation replaces only lost earnings. It does not

usually compensate for “pain and suffering” or

even the loss of physical capabilities that do not
Ch. 15—Incentives, Imperatives, and the Decision to Control 305

directly result in loss of earnings (260). “In [workers’] compensation . . . the only injuries compensated for are those which produce disability

and thereby presumably affect earning power”

(144). One example of this are injuries that are

limited to damage to the workers’ reproductive

system. The States generally do not allow compensation for this because such damage does not

reduce the workers’ earning power (144,260). In

these cases, injured and ill workers are not fully

compensated.

However, in nearly all of the States, workers

with certain kinds of permanent partial injuries

(e.g., loss of a hand or leg) receive compensation

payments based on schedules of fixed dollar

amounts for the part of the body affected. (For

a list of these, see 484. ) For the same injury, all

workers receive that same payment, even if their

wage levels differ. Thus, compensation for permanent partial injuries is often not directly tied

to an individual’s lost wages, although the payments may ultimately be based on the average

wages of all workers.

A third limitation is that some occupational injuries (and most occupational illnesses) are not

compensated at all because the worker fails to file

a claim, Some of these workers become dependent on other social insurance programs (e.g.,

Social Security) or pension programs that provide

disability benefits. Although this is mainly a problem for occupational diseases (see discussion in

the next section) it may also be a factor for occupational injuries.

Based on data from the 1972 Survey of Disabled

and Non-Disabled Adults, a Department of Labor report (596) concluded that only 43 percent

of people severely disabled by work-related injuries received workers’ compensation payments.

Severe disability was defined as complete inability

to work. The work-related disabilities were determined by analysis of survey responses and thus

the results of these surveys need to be interpreted

cautiously.

An analysis of a similar survey conducted in

1978 found that only 33.1 percent of those whose

main disability was due to an on-the-job injury

were currently receiving workers’ compensation

benefits (437). This analysis also found that workers’ compensation appeared to provide only 22.5

percent of the income maintenance for those

totally disabled by occupational injuries. The remaining three-quarters of their support came from

Social Security, employer/union retirement and

disability funds, veterans’ benefits, private insurance, welfare, and other sources. Workers’ compensation should not necessarily be “charged”

with replacing all the lost income of injured workers if other factors contributed to the total

disability. It is, however, surprising that most of

the income support for this group comes from

other sources, Employees and other public welfare programs thus may be bearing much of the

cost of occupational injuries (437).

These results may occur because the disabled

workers did not apply for workers’ compensation

benefits, because no benefits were ever awarded

or because the workers’ compensation benefits ran

out while the disability remained. Further research

is needed to determine the factors that contribute to this apparently inadequate compensation.

But from the standpoint of evaluating the incentives of workers’ compensation for prevention,

the conclusion is the same. To the extent that these

costs do not enter the workers’ compensation system, employer premiums will not rise, and employers do not face the full financial incentive to

reduce the incidence of injuries and illnesses.

Finally, one other factor may influence the

safety incentives provided by the workers’ compensation system. As is discussed later in this

chapter, under certain assumptions it is possible

that employers may pay workers additional wages

in order to attract them to hazardous jobs. If these

additional wages or hazard premiums do exist,

the creation of a workers’ compensation system

may lead only to reductions in the hazard premiums. In effect, compensation would shift from

before the accident to after the accident, and from

all exposed workers to those who incur injuries.

However, this shift may not result in any

change in injury rates (131,151,300). Three recent

studies (83,150,151) have found, in fact, that increases in workers’ compensation costs and benefits are associated with decreases in employee

wages. Two of these studies (150,151) found that

increases in workers’ compensation costs were,
306 Preventing Illness and Injury in the Workplace

at least for nonunion workers, completely offset

by decreases in employee wages. This result implies that for these employees, workers’ compensation has no net effect on employer safety incentives.

Workers’ Compensation and

Occupational Disease

As opposed to the situation regarding workplace injuries, most observers agree that many

cases of work-related disease fail to enter the

workers’ compensation system. It is clear that any

economic incentive provided by workers’ compensation will be reduced substantially if only a few

occupational illnesses are compensated. However,

representatives of the insurance industry claim

that only a few occupationally related diseases go

uncompensated (285,286).

There have been several estimates of the number of cases of occupational disease that are compensated. Data collected by the Bureau of Labor

Statistics in the Supplementary Data System suggest that only 3 to 3.7 percent of all first reports

of workers’ compensation concern an occupational disease. Barth and Hunt (46) report that the percentage of all compensation cases that concerned

occupational diseases ranged from 0.1 percent to

5.5 percent for the 12 States for which data were

available in 1975. Half these States fell in the range

between 1 and 2 percent. They also report the

results of a large survey conducted by Cooper &

Co. of 44,066 workers’ compensation cases in the

fall of 1975. About 0.8 percent of the cases concerned on-the-job heart attacks and about 2.1 percent were related to other occupational diseases.

Because there are no firm estimates of the total

number of occupational disease cases, it cannot

be said with certainty that this range of 2 to 4 percent means the compensation level for disease is

too low, too high, or just right. However, as mentioned in chapter 2, the number of all work-related

cancer cases currently reported to worker’s compensation agencies is substantially less than the

number of cancer cases estimated to be caused by

occupational asbestos exposure. In addition, because of the difficulties faced by anyone filing a

claim for occupational disease compensation (discussed in this section), it is probable that many

disease cases go uncompensated.

Barth and Hunt (46) describe a number of scientific, legal, and regulatory barriers that impair the

certain and timely compensation of occupational

illnesses. They note that the system provides a bifurcated response to disease claims. Those that

are readily connected to workplace exposure and

that are relatively inexpensive (e.g., acute dermatoses) are compensated much like accidental injuries. Disease claims that involve serious disabilities that are less clearly linked to workplace

exposures (e.g., chronic respiratory disease) are

marked by extended controversy and long waiting

periods between a claim being filed and first payment. Moreover, these cases create a disproportionate amount of administrative costs for the system. They note that “[f]or such claims the system

retains many of the undesirable features of the tort

system that workers’ compensation was supposed

to supplant” (46).

For occupational illnesses that manifest themselves only after a latent period of years there may

not be a strong economic incentive for prevention. Firms contemplating an investment that will

reduce their workers’ compensation payments 20

to 30 years from now (or even payments for product liability, as discussed later) can invest the

money elsewhere for a better return. That alternative investment may be more profitable than

the possible reduction in future compensation

costs. Moreover, the firm may not even be in existence in 20 or 30 years, and its managers will

almost certainly have changed. Thus a firm may

fail to take actions to prevent occupational illness.

On the other hand, the threat of having an occupational disease disaster similar to that associated with asbestos may outweigh this financial

calculation (286).

A number of State statutes and interpretations

of them impede compensation for occupational

diseases. For example, some States have restrictive definitions that make it difficult for disease

victims to receive compensation. Most States have

abandoned or gone beyond the “schedules” or lists

of occupational diseases, which were often unduly

restrictive (such as textile producing States that

did not list byssinosis on their schedules, or coal

mining States that did not compensate coal workers’ pneumoconiosis). Many States, however,

deny compensation for “ordinary diseases of life”
Ch. 15–incentives, imperatives, and the Decision to Control ● 307

and will compensate only those that are “peculiar or particular” to some line of work. This rule

has been applied even for occupations that face

an increased risk of contracting an “ordinary disease of life. ” Legal strictures concerning time

limitations and the requirements for proving

causation also create difficulties for compensating

people with occupational diseases (46,261).

The Surveys of Disabled and Non-Disabled

Adults provide some information concerning the

sources of income for people disabled by disease,

though, as mentioned earlier, the self-identification of “job-related” diseases means care must be

taken in analyzing the results. The 1978 survey

showed that of those who attributed their disability to bad working conditions, only 21.8 percent

had ever applied for workers’ compensation, as

opposed to 64.4 percent for on-the-job injuries.

This application rate was static between the 1972,

1974, and 1978 surveys (437).

The 1972 survey found that of those who

thought their disabling illness was due to workplace conditions, only 3 percent were receiving

workers’ compensation. The 1974 figure is essentially the same-5 percent (596). By 1978, of those

citing “bad working conditions, ” about 13 percent

were receiving workers’ compensation benefits,

compared with 33 percent for those with jobrelated injuries (437). Although about 23 percent

of total income replacement for job-related injuries comes from workers’ compensation, for

disabilities due to “bad working conditions, ” the

figure is about 12 percent. Nearly half the income

maintenance for this disease-disabled group comes

from Social Security Disablity Insurance. These

estimates have been criticized for various reasons

related to the design of the survey, the size of the

survey population, and the use of self-reporting

to describe both health conditions and the workrelatedness of those conditions (214,285,680).

However, more detailed studies of two wellknown occupational hazards, asbestos and cotton dust, support the general conclusion that most

of the income support for workers disabled by occupational illnesses does not come from the workers’ compensation system (217,431). Because both

asbestos and cotton dust have been clearly linked

to occupational disease and have received widespread public attention, they represent the “best

cases” for the compensation of disease by the

workers’ compensation system.

A study (431) of a group of insulation workers

who died from asbestos-related disease found that

of those who stopped working because of their

terminal illness, two-thirds never filed for

disability benefits from workers’ compensation

before their deaths. Of the claims that were filed,

nearly half were still pending at the time of the

workers’ deaths. When there was a surviving

widow, claims for death benefits were filed in

fewer than half the cases.

In addition, workers’ compensation was the sole

or primary source of medical benefits for only

about 4 percent of these workers. The workers

and their families appear to have relied on union

welfare funds, Medicare, other private insurance

plans, and their own savings to pay for the medical costs of asbestos-related disease. A tort liability suit was filed in fewer than one-fifth of the

cases for which data were available. In only 9 percent of the cases did the worker or spouse file both

a claim for workers’ compensation and a lawsuit.

In over half the cases (57 percent), neither a workers’ compensation claim nor a liability suit was

filed. The most important factor in explaining the

failure to file for workers’ compensation appears

to be “ignorance, either of the source of the disease or of the legal rights of survivors to compensation. ”

Johnson and Heler (236) have calculated the expected monetary losses for the families of these

workers. They estimated that the gross loss due

to disability and death from asbestos-associated

disease amounted to over $250,000 per family.

Half the widows they studied received no benefits at all. The other half received a variety of benefits. About 28 percent of these benefits came from

workers’ compensation, while 16 percent came

from tort suits and settlements. The remainder

came from Social Security, private pensions, and

veterans’ benefits. Johnson and Heler also calculated the net financial losses for these families. On

average, the widows who received benefits had

approximately one-third of their losses replaced.

In theory, through the workers’ compensation

system, employers bear the costs of occupational

disease. But for this group of workers, about 85
308 ● Preventing Illness and Injury in the Workplace

percent of the gross wage loss was borne by the

families of the affected workers. Of the small portion of lost wages that were replaced, less than

half were paid for by employers through workers’ compensation and by producers through tort

suits and settlements.

Hughes (217) has similarly studied income replacement for a group of workers exposed to cotton dust who developed byssinosis, He found that

workers’ compensation replaced only 6.9 percent

of the estimated lost income for this group. Forty

percent of lost income was replaced by funds from

Social Security, 3.5 percent from Veterans Administration benefits, and 2.6 percent from private

pension plans. The total income replacement

amounted to about 53 percent of expected earnings. “Even with Social Security funds in crisis,

it is apparent that a massive shift of costs has been

made from the employers to the general taxpaying public, due to an almost nonexistent workers’ compensation system—a form of public subsidy to disease-producing industries . . . “ (217).

Role of Insurers

Beyond the incentives faced by private employers, insurance carriers might have an independent financial incentive to prevent injuries and illnesses. If an insurance company can improve the

loss experience of its policyholders, it maybe able

reduce the amount that must be paid out in claims.

In practice, however, this incentive is limited,

too. Low benefit levels reduce the incentives to

insurers just as they reduce the incentives to employers. In addition, if the merit-rating system is

working properly, insurers will have little incentive to improve the loss experience of firms that

are fully merit-rated. For such companies, the benefits of reduced claims will be received by the employer.

Insurers will receive an independent benefit

only if they can cut losses in the time period before

the premiums are adjusted by the experience factors. Insurers will also benefit if they can reduce

the losses for firms that are not fully merit-rated.

However, insurance industry representatives

argue that reduced rates are important for attracting and holding customers, and that maintaining customers is a powerful incentive for reducing claims and therefore rates (286).

In fact, many insurers provide loss-control services to their policyholders. The results of one

survey imply that private insurers and State workers’ compensation funds provided a total of 1.6

million such visits to policyholders in 1974. Private insurers provided 1.5 million of these visits

(472,473). More recently it has been estimated that

the insurers who are members of the two major

trade associations (the Alliance of American Insurers and the American Insurance Association,

or AIA) employed about 8,600 loss-control specialists in 1983, while independent firms added

about another 1,000, for a total of 9,600. The

8,600 specialists working for the members of the

two associations conducted about 1.5 million

visits to policyholders. It is also estimated that

about 177,000 samples of suspected toxic substances were analyzed in 1983, while approximately 40,000 policyholders participated in training programs provided by the Alliance and AIA

member companies (286).

Some of the expenditures for “loss control” are

expenses for inspecting workplaces in order to determine the nature of the operations and to set

premiums (30,473), rather than to suggest or mandate preventive actions. Little statistical information is available to determine the percentage of

insurer visits that are primarily for collecting information for rate-setting and the percentage of

visits that provide safety advice (473).

Aside from this rate-setting activity, insurers

have offered loss-control services as one way of

competing in an industry that until recently was

subject to detailed price and service regulation by

State agencies. In general, that regulation did not

allow insurers to compete by charging different

rates. It is not clear what effect various efforts to

“deregulate” this industry will have on the provision of loss-control services (268).

However, although insurers do provide consultative services to their policyholders, they generally do not grant rate decreases to employers who

accept such services. It is likely that the advice

provided by insurers has a positive effect on

safety, but this effect may be limited by fear that

the employer, a valued client, will simply change

insurance companies rather than make a large expenditure for health and safety controls.
——

Ch. 15—Incenfives, Imperatives, and the Decision to Control ● 309

To the extent that occupational diseases do not

enter the compensation system, there is no financial incentive to prevent them, either on the part

of the employer or the insurer. Compensation for

illnesses will also be discounted substantially because of the latent period between exposure and

disease manifestation. The insurance industry,

however, maintains that it is taking steps to avoid

future occupational disease disasters similar to the

asbestos situation (286,675).

Changes in Workers’ Compensation

In practice, the workers’ compensation system

only provides a limited economic incentive for

prevention, especially for occupational illnesses.

Changes have been suggested to improve economic incentives provided by this system. These

include increasing the degree of experience-rating

in the compensation system (317), instituting employer deductibles or copayments for the first $500

of compensation expenses (449), and changing the

Federal income tax deductions allowed for workers’ compensation premiums (228). However, because workers’ compensation is currently administered by the States, the first two suggestions

would involve changes in each of the States or

creation of a single Federal system.

Moreover, the effects of the suggested changes

are not completely clear. For example, Victor

(656) suggests that the creation of employer deductibles might increase the incentives faced by

some employers while decreasing the incentives

faced by other employers. The net effect on injuries is unclear. In addition, increasing the economic incentives of workers’ compensation could

increase employers’ incentives to contest claims,

as well as their incentives to prevent illness and

injury. Finally, many of the limitations of injury

taxes (discussed in ch. 16) also apply to these suggested changes in the workers’ compensation

system.

There has been considerable recent discussion

concerning the possibility of creating a Federal

system to compensate for occupational exposures

to asbestos (517). Prevention should be a consideration in any changes in compensation. A compensation system should be designed to “internalize” the costs of disease. In other words,

producers and employers should bear the costs

of occupational disease (14). However, the use of

Federal funds to supplement an occupational disease fund may dilute this incentive. If Congress

takes action concerning occupational disease compensation, this action could include a requirement

that companies take concrete steps to prevent

future cases of disease.

Tort Liability

The effects of court-enforced tort liability on

employer practices concerning health and safety

has been highlighted by the large number of lawsuits concerning worker exposure to asbestos (box

R). In particular, attention has focused on the

well-publicized case of one supplier of asbestos,

the Manville Corporation (formerly Johns Manville), which has filed for a corporate reorganization under the bankruptcy laws because of the

burden of paying numerous liability suits. Facing the threat of potentially costly lawsuits and

large awards for damages, employers and manufacturers may take action to improve workplace

health and safety.

As discussed in chapter 11, before the passage

of workers’ compensation laws in the early part

of this century, injured workers could sue their

employers for damages. They encountered substantial difficulties in winning these suits, however. Workers’ rights to sue their employers were

greatly restricted with the creation of the workers’ compensation system. For most cases of occupational injury or illness, workers are not

allowed to sue their employers for such compensation. Instead, the workers’ compensation system, in theory, provides a specified level of benefit that is awarded to pay medical costs and

compensate for lost wages.

In general, the law of torts provides the opportunity to sue for monetary compensation when

property has been damaged or a person has been

injured, but precisely defining the field of tort law

is difficult. One noted scholar has written:

A really satisfactory definition of a tort has yet

to be found. . . . Included under the head of torts

are a miscellaneous group of civil wrongs, ranging from simple, direct interferences with the per-
310 ● Preventing Illness and Injury in the Workplace

I

Asbestos Use

19s0. .-, *
textile fibers, and polypropylene fibers.

son . . . or with property . . . up through various forms of negligence. . . The law of torts . . .

is concerned with the allocation of losses arising

out of human activities. . . So far as there is [a

general principle] . . . it would seem that liability must be based upon conduct which is socially

unreasonable . . . or unreasonable interference

with the interests of others . . . (Presser. Quoted

in 379).

Baram (379) notes that controversies involving

risks to human health have traditionally involved

legal concepts grouped under tort law. Four areas

of tort law have been used to resolve controversies that involve such risks: negligence, product

liability, nuisance, and strict liability. Of these,

negligence, product liability, and strict liability

are applicable to issues of workplace health and

safety.

Negligence has been defined as “conduct which

falls below the standard established by law for

the protection of others against unreasonable risk

of harm. ” To maintain a suit based on negligence,

four elements must be shown: the existence of a

legal duty or obligation to protect people from

harm, a failure to conform to that duty, a proximate causal connection between that failure and

a resulting injury, and an actual injury (379).

Under the general doctrine of negligence, a person can be held liable for an injury if he or she

failed to act in a “reasonable” way to prevent the

injury.

Product liability developed out of warranty

law. The courts have ruled that manufacturers

and sellers implicitly warrant that their products

are suitable and safe for all reasonably anticipated

uses. Whether or not the seller was legally negligent is irrelevant in this situation because the very

fact of the defect indicates a breach of the warranty (203).

Under strict liability, the manufacturer is liable for injuries resulting from a defective product that is unreasonably dangerous, without regard to fault or contractual limitations. Here, the

degree of diligence or care in preventing injuries

is immaterial (203). Strict liability has traditionally

been used for “ultrahazardous” or “abnormally

dangerous” activities (42). In recent years, the

courts have adopted in the field of product liability law some of the concepts of strict liability.

In fact, product liability suits can be based on

negligence, warranty, and strict liability. Liability is now applied in cases where: 1) a product

was defectively designed, 2) a product was defectively manufactured, or 3) a product was sold

without proper warnings concerning its use and

dangers.

The “duty to warn” has been the basis for many

of the successful lawsuits concerning asbestos exposures, in which courts have ruled that the manufacturer has an obligation to take reasonable actions to discover the hazards associated with a

product and to warn accordingly. This duty may

include specialized testing (69):

The manufacturer is held to the knowledge and

skill of an expert. . . [This] means at a minimum

he must keep abreast of scientific knowledge, discoveries, and advances and is presumed to know

what is imported thereby. But even more importantly, a manufacturer has a duty to test and in-
312 ● Preventing Illness and Injury in the Workplace

spect his product. The extent of research and experiment must be commensurate with the dangers

involved.

By far the most common use of tort actions in

occupational safety and health are suits against

a third party—for example, the manufacturer of

products purchased by the employer for use in

the workplace. Thus, employees injured by a malfunctioning punch press can sue the manufacturer

of the press, while employees who used asbestos

in their work can sue the manufacturer of the

asbestos product. Because the ill or injured worker

is not directly employed by this third party, lawsuits concerning work-related illness or injury are

not prohibited by workers’ compensation laws.

Although many employers are concerned about

legal liability, in most cases it does not directly

affect them as employers. Rather, it affects the

products that they sell to consumers or to other

employers. In 1978 it was estimated that while

only 11 percent of all product liability awards involved work-related injuries and illnesses, these

cases accounted for 44 percent of the total dollars

awarded for product liability (228).

This slightly roundabout approach of thirdparty suits may lead ultimately to improvements

in working conditions and in the health and safety

of the work force, but a number of factors limit

its effectiveness. The first is that it does not apply

to employers, even in cases in which the employer

may have been in the best position to ensure that

the equipment and products were being used in

a safe and healthful fashion. In these cases, the

manufacturer is still held responsible.

Other limitations on the usefulness of thirdparty suits are found in the traditional degree of

proof demanded by the courts in liability actions.

This burden of proof is often very difficult for the

worker, especially in cases of occupational disease. The problems employees can encounter

include:

It is difficult to prove (or even recognize) that

harm has occurred when a disease, such as

cancer, may be caused by many factors, including occupational ones.

The isolation of the product or products that

“caused” the harm is difficult, especially if

there are harmful interactions with other

●

●

●

products, or when the proof for the causal

connection is only through statistical inference.

The long periods of time that often elapse between exposure and effect make the causal

connection and the identification of products

and manufacturers much more difficult.

Even if the manufacturer can be identified,

the firm may have gone out of business, be

currently unprofitable, or otherwise not able

to pay damages.

In some States, statutes of limitations bar

suits for damages beyond a certain length of

time (generally 3 to 10 years) after the last

exposure to the hazard, even if the disease

only manifests itself 20 or 30 years later (203).

As noted earlier, State workers’ compensation

laws generally bar suits by employees against their

employers, although there are several exceptions

to this. First, any employer that is not covered

by the State workers’ compensation law may be

sued. Some employment categories that commonly fall in this group are agricultural employees, domestic servants, employees of very small

businesses, railroad workers, and employees of

charitable organizations (407).

Second, courts may grant employees “injunctive and declaratory relief. ” In one case, Shimp

v. New Jersey Bell Telephone Co., an employee

obtained a court injunction to require the employer to prohibit smoking in general working areas.

The court ruled that such an injunction would not

be barred by the workers’ compensation law of

New Jersey and that the employee, who was allergic to cigarette smoke, had a common-law right

to a healthful work environment. It is not clear

whether other courts will also adopt this reasoning (407).

Third, in nearly all States workers can sue employers for damages in cases of willful or intentional acts. This includes situations in which the

employer actually intended that the employee be

injured, as well as cases that involve fraud or

deceit. by the employer. For example, if an employer deliberately conceals from a worker information concerning a work-related illness, employees may be successful in collecting damages from

the employer. The West Virginia Supreme Court
Ch. 15—Incentives, Imperatives, and the Decision to Control ● 313 —

extended this rule to cases of willful, wanton, or

reckless employer misconduct (407), although this

was subsequently restricted by a new State law

(2,342).

Fourth, in some jurisdictions an employer may

be sued by an employee when acting in a “dual

capacity. ” The three main types of dual capacity

cases involving workplace health and safety issues

are based on the obligations of the employer as

land owner, medical practitioner, or seller of

products. Thus an employer, for example, who

offers an onsite medical service and who negligently treats an employee maybe sued for medical malpractice. Similarly, an employer may also

be sued by a worker for injuries or illnesses incurred due to a product manufactured by the employer. It should be noted that only a minority

of jurisdictions currently allow such “dual capacity” suits (407).

It has been suggested that employees be allowed

to sue their employers. For example, Amchan (2)

has proposed that workers and their families be

allowed to sue employers if the worker is killed

or permanently disabled due to the “willful, intentional, or grossly negligent conduct” of the employer. Although such change might enhance employer incentives for prevention, it would also

have a number of social, legal, and economic implications that need to be considered carefully.

The future importance of tort liability as an incentive to control workplace hazards is unclear.

Although much attention has been given to the

circumstances of asbestos exposure, asbestos may

not be typical. Currently the prohibition of most

employee suits against employers severely weakens

the incentive. In addition, the practical problems

of proving causation will tend to limit to just a

few hazards the lawsuits by workers against suppliers.

Congress is currently considering legislation to

change certain aspects of product liability law. As

suggested earlier for changes in workers’ compensation it is important that the effect of these

changes on incentives for prevention be considered carefully,

Labor Market Forces, Collective

Bargaining, and Workerss Rights

To some extent, employers are motivated to improve employee health and safety because of pressures from the labor market. Economists since

Adam Smith have hypothesized that employers

would have to pay more to attract workers to jobs

with unsafe conditions or other adverse working

conditions. In theory, if there is complete information about workplace hazards and alternative

job opportunities, employers may find that they

cannot attract enough workers. There are then

two basic choices—raise the wages or reduce the

hazards. Thus, the possibility exists that this labor market pressure may induce improvements

in employee health and safety.

The payment of additional wages for occupational risks can be seen in the existence of “hazardous duty pay” in certain high-risk occupations.

But these additional wages may also be built into

the general pattern of wages for an industry or

occupation. In this situation, they would not be

directly observable, but would be included as part

of the total wage. The additional wages paid for

workers exposed to occupational risks have been

termed “hazard premiums” or “compensating

wage differentials. ” In theory, various statistical

techniques could be used to separate the factors

that determine wages, thus testing whether a “hazard premium” existed and determining its size. In

practice, the data are difficult to analyze because

of problems in measuring job risks and in adjusting for other factors that influence wages.

To date, the published studies on this question

have generally found compensating wages for increased risks of death, but are inconsistent on

whether there are also compensating wages for

increased risks of nonfatal injuries. In fact, several studies have found, contrary to expectations,

that some groups of workers were not receiving

compensating wages. In some cases hazardous

work was associated with lower wages (138,192).

Moreover, even the studies that have found increased wages for hazardous work have not been

consistent on the size of these increased wages or
314 Preventing Illness and Injury in the Workplace

the implied “value of life.” (See ch. 14 for a table

presenting this wide range of values. For reviews

of this literature, see 191 and 448. )

In addition, employers may find that their

workers are quitting soon after starting work because of unsafe or unhealthful working conditions

(658a). Efforts to reduce such turnover and to improve employee morale may lead to investments

in health and safety controls.

Of course, all these labor market pressures are

vitally dependent on the existence of alternative

job opportunities. In areas and times of high unemployment, this incentive to control hazards will

be substantially reduced. Moreover, other labor

market imperfections, such as incomplete information about job hazards, the costs of searching

for jobs, and unequal bargaining power also limit

this incentive.

Collective Bargaining Agreements

Negotiation and collective bargaining can also

bean incentive. This requires that unions be committed to the recognition of health and safety concerns and assign high priority to these issues in

collective bargaining. Other important union obligations for the success of this strategy include being fully informed about OSHA regulations, enforcement procedures, and employee rights under

the OSH Act. In addition, the union must establish a system to monitor employer actions, usually through safety stewards or trained local representatives, as well as develop procedures for

hazard identification, management negotiation

procedures, enforcement of committee findings,

and rank-and-file feedback about these findings

(253).

Labor unions can exert influence because their

representatives can be present for all plant operations, every working day. However, because the

collective bargaining process involves a process

of negotiation and compromise, unions may make

tradeoffs between economic benefits (including

greater wages, job security, and fringe benefits)

and more attention to occupational hazards.

There are approximately 150,000 separate collective bargaining agreements in the United States,

and 82 percent of these contain some reference

to health and safety. Apparently, emphasis on

these issues at the plant level has increased during the last decade. This may be because of a belief

“that control and prevention of job hazards can

be improved through the combination of more effective OSHA rules, regulations, and enforcement

programs with trade union programs, including

more effective collective bargaining contracts and

their administration” (185).

The Bureau of National Affairs (BNA) has tabulated the major provisions in over 5,000 collective bargaining agreements and analyzed closely

a representative sample of 400 contracts (77).

Table 15-1 illustrates the frequency of health and

safety provisions in collective bargaining language

from 1954 through 1981. Until 1971, according

to the BNA, there was only a slight increase in

the prevalence of such provisions: for example,

from 38 percent of contracts in 1954 requiring

management to “take measures” to protect the

workers to 42 percent by 1971. The only type of

contract provision that showed more than a slight

increase was that for safety committees.

Passage of the OSH Act in 1970 coincided with

an increase in the number of contracts that included health and safety clauses, and the provisions became increasingly specific. The overall frequency of safety and health clauses between 1954

and 1970 had remained between 60 and 65 percent, but by 1975, 82 percent contained such

clauses. There was also an increase of 11 percentage points in clauses requiring employer compliance with laws from 1971 to 1975.

The general statement of responsibility in most

contracts states that the company must make “reasonable provision for the health and safety of the

employees, “ which appears to be redundant with

the general duty clause of the OSH Act (see ch.

12). Moreover, 29 percent of the contracts in 1981

required the company to comply with present

legal standards. These provisions enable local

unions to use the grievance process (an internal

dispute mechanism negotiated by labor and management for the resolution of employee complaints) to change or influence health and safety

conditions, in addition to filing an OSHA complaint.
Ch. 15—Incentives, /imperatives, and the Decision to Control ● 315

Table 15-1.—Percentage of Contracts Containing Health and Safety Clauses,@ 1954-81

Company obligation Employee obligation Other

To meet To provide To provide Must wear provisions

To take legal safety first-aid safety Must obey Safety

Years Clauses measures standards equipment equipment equipment safety rules committees

1954 . . . . . . 600/0 380/o 13 ”/0 270/o 11 ”/0 7% 17“/0 180/0

1961 . . . . . . 65 34 11 32 16 7 11 28

1966 . . . . . . 62 35 NA 28 12 6 8 29

1971 . . . . . . 65 42 15 32 14 7 13 31

1975 . . . . . . 82 50 26 36 21 NA NA 39

1981 . . . . . . 82 50 29 42 21 NA NA 43

%cmsiderable overlap was noted in all categories

NA—Not available

SOURCE (77)

Joint Labor-Management Health and

Safety Committees

Joint committees vary in structure, organization, and capacity for intervention. The role of

the committee ranges from a limited monitoring

of workplace routines to a strong source of pressure on workers, union, management, and OSHA.

The proportion of contracts with a clause concerning health and safety committees rose from

18 percent in 1954 to 43 percent in 1981, with most

of the increase following passage of the OSH Act

(see table 15-1).

The growth in labor-management safety and

health committees may represent an attempt on

the part of both labor and management to resolve

issues at the local level. An important factor in

a union’s ability to improve safety and health is

rank-and-file concern about these issues and the

relative priorities that union members and their

leaders place on health and safety in relation to

other negotiable provisions, such as wages, work

hours, seniority, and grievance procedures. According to Kochan and his colleagues, the most

important determinant of committee effectiveness

from the management perspective is the attitude

and commitment of the top management. It is also

important that there be a balance of strengths between both bargaining groups. Acting as an external pressure, the presence of OSHA may place

a weak union in a more equal bargaining position with management (253).

Collective bargaining is commonly associated

with opposition in interests and an atmosphere

of limited trust, but there may be “integrative”

issues over which parties share common goals. It

has been suggested that safety is such an “integrative” issue, leading to a capability for cooperative problem solving on safety issues through

health and safety committees in the context of an

overall bargaining relationship (253).

Collective bargaining often serves as a direct

and immediate stimulus for setting up these committees. However, it does “not guarantee that an

active and ongoing committee will develop” (253).

Indeed, there are numerous instances where the

presence of a contract clause requiring safety committees has not resulted in regular meetings or useful recommendations by functioning committees.

There has been only a limited amount of research assessing the impact on worker health and

safety of these joint committees. Kochan, Dyer,

and Lipsky studied union and management attitudes in 59 plants (253). For several reasons, they

were unable to obtain data on actual injury and

illness experience at these plants. Thus their results

are generally based on subjective perceptions of

workers and managers from surveys and interviews.

They attempted to describe the conditions

under which labor-management committees

would have a high level of activity and would

continue to function. These conditions occurred

when OSHA pressure was perceived to be strong,

when the local union was perceived to be strong,

when there was substantial rank-and-file involvement in health and safety issues, and when management approached these issues in a problemsolving manner. The committees that produced

the largest number of recommendations tended

to have a high level of input from the local union

membership, frequently reported back to those
316 Preventing Illness and Injury in the Workplace

members, and were in workplaces with a high

proportion of young workers. The degree of top

management commitment was also a very important variable for determining the success of these

committees. In particular, management tended to

adopt a problem-solving approach to health and

safety issues when they were under pressure from

OSHA to comply with particular regulatory requirements (253).

Cook and Gautschi (121) used data for 113

manufacturing firms in Maine to study the effectiveness of OSHA and labor-management committees. They found a favorable effect on plant

injury rates from OSHA citations. In addition,

there was some evidence that union-management

safety committees were also effective in reducing

injury rates. For the plants with 300 or more employees, this effect was significant at the 90 percent confidence level. However, for all the plants

with 200 or more employees, the effect was not

statistically significant.

California has created a program to encourage

the formation of joint committees on construction sites. Under this “Cooperative Self-Inspection

Program, ” a site will be exempt from routine

OSHA inspections if a joint committee is set up

to perform regular inspections of the workplace.

This program has been implemented on six projects. The California Division of Occupational

Safety and Health reports that the injury rates at

these worksites are “substantially lower” than

both the rates for other California construction

projects and the experience of these same companies at other sites not included in the program

(337,347).

In a study of survey responses from 127 firms

in Massachusetts, Boden and colleagues (66)

found that the “mere existence” of a joint committee in a workplace had no effect on either the

number of OSHA inspections prompted by worker

complaints or the relative hazardousness of the

firm as measured by serious OSHA citations. The

researchers also conducted more detailed interviews with union and management representatives

at 13 of the firms with labor-management committees. The data from these interviews suggest

that the committees that were perceived as “effective” apparently increased perceived safety

(leading to fewer worker complaints to OSHA)

and improved employer compliance with OSHA

standards (leading to fewer citations) (see also 335

and 341 and box S.)

OSHA and Workers’ Rights

The OSH Act itself created a number of opportunities for worker participation concerning occupational safety and health. The act provided

that

●

●

●

●

●

●

workers could:

request OSHA inspections,

participate in the conduct of an OSHA inspection,

participate in any of the stages of a proceeding before the Occupational Safety and

Health Review Commission,

contest the “reasonableness” of the abatement date set by OSHA,

participate in standards development and the

issuance of variances, and

request a Health Hazard Evaluation from the

National Institute for Occupational Safety

and Health.

The right to participate in Occupational Safety

and Health Review Commission proceedings and

to contest OSHA citations has been the subject

of several court cases. The result of these cases,

interpreting the language of the OSH Act, is that

employees and their unions can participate in

these proceedings if the cited employer is contesting a citation. Employees and unions also have

an independent right to contest the reasonableness

of the prescribed abatement date. However, employees and unions do not have an independent

right to contest an agreement between OSHA and

the employer concerning the nature of the required controls, the type of citation, or the penalty amount. If OSHA and an employer agree on

these issues and the employer withdraws its “contest” before the Review Commission, the employees can object only to the specific abatement dates.

(See 307 for excerpts from several of the important cases on this issue. )

In addition, the act created a mechanism in section 11(c) to protect employees from job discrimination for having exercised any of the rights listed

above. However, the resources devoted to OSHA’s
—

Ch. 15—lncentives, imperatives, and the Decision to Control 317

Box S.—Collective Bargaining Results: Worker Training and Health and Safety Committees

Training Concerning Health, and Safety

Approximately 420,000 of the total 800,000 General Motors (GM) employees are members of the

United Automobile Workers (UAW). The UAW-GM contract provides for training of full-time union

health and safety representatives for each GM plant with more than 600 employees (37). The full-time

union safety representatives, selected first by the locals and finally by the UAW international headquarters, train alongside GM’s own safety representatives for 40 hours at the General Motors Institute. Training

involves hazard recognition, OSHA complaint procedures, and OSHA regulations. In accord with the

UAW-GM contract, the union representative accompanies his or her management counterpart twice

monthly on inspections, and also walks with OSHA inspectors on their tours. The union member’s role

also includes reviews of training and education programs and accident reports, and the person is empowered to shut down a hazardous operation, but only with joint approval by the plant safety officer.

In addition, the union safety and health representative is involved in the initial stages of grievance resolution concerning health and safety issues.

Some unions that represent workers who move frequently from worksite to worksite, such as the

International Brotherhood of Painters and Allied Trades (lBPAT) and the United Association of Plumbers

and Pipefitters, also place high priority on the training and education of their workers and union safety

representatives. Part of this attention is directly related to securing desirable contract language concerning health and safety. IBPAT has concluded, for example, that its training program had a “statistically

significant impact on collective bargaining, leading to more and better safety and health bargaining language in both local and district.”

Labor-Management Committees

One refinery plant of the Shell Oil Company that has 2,000 workers organized by the Oil, Chemical and Atomic Workers (OCAW) also has contractual provisions for union-management committees.

The current contract language was drawn up in 1973. Unlike most OCAW contracts, this one provides

no trained hygienist to survey worksites regularly. It does, however, provide for a union-management

health and safety committee that:

● is to be composed of an equal number of representatives from the hourly and staff [management] groups ,

., and is to meet periodically to discuss health and safety matters and make recommendations to management. # Where a recommendation made to the company is not accepted, an explanation will be made to the committee. $-

,, Decisions by the company with respect to heaIth and safety recommendations shall not be subject to the griev-

* . ance and arbitration procedures of the articles of agreement (emphasis added). u.

~ Company perceptions, however, differ. Shell has described the joint committee policies as having

:.? “dispelled rumors and improved relations” between the adversarial parties, and having “removed the >.’

q, mystery” with regard to company initiative and support of workplace health and safety. Management

 representatives felt that these issues were best handled in the joint committee setting, and contended

~’ that union desires to use the grievance procedure were often motivated by wanting to push other issues

into the grievance setting “under the guise of safety.” -,

,,. .-
enforcement of this have been very limited. Moreover, employees do not have a right to pursue a

court-ordered remedy independently, but must

rely on OSHA to negotiate a settlement or file

suit. Thus, one commentator has suggested that

the implementation of this provision “has been

seriously flawed” (406).

This protection from discrimination covers

workers who refuse to engage in imminently hazardous work. An OSHA regulation prevents employers from disciplining employees for such a refusal if there is insufficient time to eliminate the

danger of death or serious injury through any

other means. In Whirlpool Corp. v. Marshall, the

U.S. Supreme Court unanimously upheld this regulation (307,408). This right is limited to refusing imminent injury hazards and does not extend

to most chronic health hazards.

Under a provision in the National Labor Relations Act, employees who refuse to perform hazardous work may be protected from disciplinary

action if they are acting together and in good faith

(408). Recently, however, the National Labor Relations Board ruled that this did not apply to one

worker who refused a hazardous assignment because he was acting only by himself (328).

Of great importance to effective worker participation in labor-management activities is the

availability of information to workers and their

unions about plant-specific hazards. The OSH Act

has several provisions requiring that employees

be fully informed about health and safety issues.

The act provides that OSHA issue regulations requiring that employers inform employees of the

protections and obligations provided by the act

and the standards that apply to their workplaces

(section 8(c)(l)).

The OSH Act also mandates OSHA to issue

regulations requiring employers to maintain records of employee exposures, to provide employees and their representatives with the opportunity

to observe employer-conducted exposure monitoring, and to provide access to these records.

Employers are also required to notify employees

who have been or are being exposed above permissible limits and inform them of “the corrective action being taken” (section 8(c)(3)). Finally,

the Act requires that standards issued by OSHA

“shall prescribe the use of labels or other appropriate forms of warning as are necessary to insure that employees are apprised of all hazards

to which they are exposed, relevant symptoms

and appropriate emergency treatment, and proper

conditions and precautions of safe use and exposure” (section 6(b)(7)).

Several OSHA regulations give workers and

their unions the right to obtain information from

employers. For example, an OSHA regulation

issued in 1978 requires that the employer-maintained Log of Injuries and Illnesses be made available to workers upon request, and employers are

required to post a summary of the log each year.

The OSHA Access to Records regulation and recent rulings by the National Labor Relations

Board also assist unions and workers in obtaining information concerning exposures and employer-held medical records. Finally, as discussed

earlier in this chapter, various state and local
Ch. 15–incentives, /imperatives, and the Decision to Control 319

right-to-know laws and the recent OSHA regulation concerning hazard communication may

also aid workers and their unions in learning

about hazards. (For further discussion of employee rights, see 307, 333, and 408. )

Possible Changes in Workers’ Rights and

Collective Bargaining

It has been proposed that workers’ rights concerning workplace health and safety be expanded.

Several observers have argued, based on the experience of other countries, that health and safety

improvements could be made by enhancing workers’ rights to full information on job hazards, requiring worker participation in health and safety

decisions, and permitting workers to refuse all

work assignments they consider to be hazardous

(64,242,677).

In Sweden, for example, since 1974, every establishment with five or more employees must

have at least one worker-elected health and safety

steward; larger workplaces typically have a steward for each area of the workplace with one

worker designated as the chief health and safety

steward. The health and safety stewards have the

authority to inspect the workplace for hazards,

are involved in the design of the workplace, and

have the right to examine company records. They

also have the authority to order, for health and

safety reasons, that a particular plant operation

be shut down, even over the objections of management. In cases of a labor and management dispute, the operation remains shut down until a

government inspector visits the workplace and

resolves the issue.

In addition, all workplaces with 50 or more employees must have a labor-management health

and safety committee. The committee discusses

plans to improve working conditions, is involved

with the design of new facilities and worker training, and supervises the company health and safety

staff. Although the workers have a majority on

these committees, most decisions are reached by

consensus of both labor and management representatives. Finally, a number of different types of

training courses have been developed for workers, supervisors, and the worker health and safety

stewards. These courses are commonly administered by the Swedish trade unions, both at trade

union schools and in worker-organized “study

circles” (64,242,677).

As described in chapter 10, employers, unions,

universities, and other groups in the United States

have developed and administered worker training and education programs. The “right to know”

movement in this country (discussed earlier) reveals the desire of many workers, unions, and

communities for complete information about

workplace hazards and for greater involvement

in health and safety issues. In addition to the

“right to know, ” Mazzocchi has suggested that

workers be afforded a “right to act .“ This would

mean that, in each workplace, a worker would

be “deputized” to represent fellow workers in seeking outside assistance to evaluate information obtained under the “right to know” laws and the

OSHA “hazard communication” standard (345).

However, direct application in the United States

of the experience of other countries will be impaired by differing legal, cultural, economic, and

political conditions. In addition, greater employee

involvement in health and safety would represent

changes in the traditional authority of management to make decisions concerning all working

conditions.

It has also been suggested that greater use of

collective bargaining could improve occupational

safety and health. Collective bargaining agreements can detail procedures and investments that

are tailored for individual plants and firms, thus

decentralizing the process of implementing health

and safety controls. The result, it is claimed, can

be health and safety improvements that are both

“more efficient and more effective” than those produced by the current system of national regulatory standards (37).

There are three significant factors that limit the

effectiveness of collective bargaining in improving occupational safety and health. First, only

about 20 million workers, or about 20 percent of

the U.S. work force of 100 million, belong to labor unions. Moreover, the percentage of the labor force belonging to unions has been declining

since the 1950s. This may represent the result of

social and cultural patterns and the preferences

of U.S. workers and managers, but it should also
320 ● Preventing Illness and Injury in the Workplace

be noted that U.S. law has not always permitted

collective bargaining. Because of this, one labor

union representative on the advisory panel for this

assessment suggested that changes in labor relations law have health and safety implications.

Second, not all unions have the kinds of expertise in industrial hygiene, injury prevention, or

occupational medicine needed to negotiate and enforce agreements on occupational health and

safety. A recent survey of 14 U.S. labor unions

shows that union spending on worker health and

safety ranged from about 20 cents to over $15 per

member. These 14 unions employed only two fulltime physicians and one part-time one, while the

majority of these unions employ few full-time industrial hygienists, public health professionals, or

other health and safety staff (678).

Third, by definition safety and health provisions must compete for attention and resources

with other bargaining issues. In periods of economic downturn, workers and their unions, concerned about maintaining wage levels and preserving employment security, may push safety and

health issues down the list of priorities.

Government Regulation

The final factor that influences employer decisions to control hazards is an imperative: the regulations and standards issued by Government

agencies, mainly OSHA. As detailed in chapter

12, OSHA has been empowered to issue mandatory regulations, to conduct inspections, and to

propose penalties and require correction when it

finds violations of those regulations. OSHA regulations are often the focus of health and safety

discussions because they require response and

compliance. Nevertheless, they are limited as a

factor in health and safety because few regulations

have been promulgated and enforcement is spotty.

Any changes in this, however, will occur only if

Congress and the executive branch act to increase

OSHA resources or change standard-setting and

enforcement procedures.

(As part of this assessment, Mendeloff analyzed

some of the factors that affect compliance with

several OSHA health standards. See box T.)

In addition to OSHA, other Federal agencies

may require employer actions that either directly

or coincidentally improve worker health and safety. Using the authority granted by several different statutes, both the Environmental Protection Agency (EPA) and the Consumer Product

and Safety Commission (CPSC) regulate products

that may also be workplace hazards. For example, EPA regulates the production of pesticides

and requires notification before other chemicals

are manufactured in order to protect public health

and the environment. EPA’s regulations, in many

cases, also reduce worker exposures.

For some toxic substances, in fact, workers may

be the only significantly exposed group. In light

of their overlapping authorities, EPA and OSHA

have considered joint regulatory proceedings. The

most recent public announcement of this has involved possible regulation of methylenedianiline,

although it now appears that the agencies have

decided that OSHA, not EPA, will take responsibility for regulating workplace exposures (346,

354).

Regulation of the products purchased by businesses may, in some cases, be more cost-effective

than requiring installation of industrial hygiene

controls. For example, a number of workers exposed to formaldehyde are employed in establishments where the only source of exposure is the

emission of formaldehyde from products supplied

by other industries. These include apparel manufacturers using cloth treated with formaldehydebased resins and office workers who are exposed

to formaldehyde from particleboard or plywood

products in their offices. In these cases, standards

concerning formaldehyde emission rates or product content might be both less expensive and easier

to enforce than efforts to increase general ventilation in numerous small establishments in dispersed

locations (206).

One way to issue standards for these hazardous products used in the workplace would be coordinated regulatory efforts between OSHA and

the EPA or the CPSC . This approach holds some

promise for reducing the hazards of products purchased by small businesses. However, this approach will have only a limited impact on hazards

related to the improper use of products in the

workplace. In addition, there are difficulties in

regulating products already manufactured and in

use.
Ch. 15—Incentives, Imperatives, and the Decision to Control . 321

Box T.—Factors Affecting Worker Exposures

On contract to OTA, Mendeloff analyzed OSHA inspection data from 1973 through 1979 for four

substances: lead, trichloroethylene, asbestos, and silica. Mendeloff developed several different measures

of employee exposure and attempted to explain observed variations in exposure using other information

included in the OSHA data. His analysis was limited because, first, not all inspection results were included in the OSHA computer system. Second, the results of his analysis explain only between 5 and

25 percent of the variation in the dependent variables. Thus, the variables he was able to test do not

capture all the factors that determine success in controlling hazards (301).

Mendeloff found that complaint and programed inspections were equally effective in discovering employer noncompliance with OSHA standards. Mendelhoff predicted that the presence of a union at

an inspected establishment would contribute to lower exposures and fewer citations. However, this was

not supported by the OSHA inspection data. He did find that, other things being equal, exposures tended

to be higher at plants in nonmetropolitan (rural) areas compared with those in metropolitan areas. It

might be speculated that workers in nonmetropolitan areas have fewer job choices and are thus more

willing to tolerate higher exposure levels. Alternatively, it could be that information about hazards and

controls reaches rural areas more slowly or is adopted more reluctantly there.

Size of establishment was also examined. The results indicate that both large and small establishments

were less likely to have overexposures than medium-sized establishments, paralleling the situation with

injuries in which medium-sized establishments appear to have higher rates. However, in many cases the

differences between the various establishment sizes were not statistically significant. Moreover, interpretation of the observed differences was hampered by ambiguities in the definitions of the employee

exposure variables.

Mendeloff also examined the possibility that employer efforts to control hazards depended on the

cost of doing so. Using information from an OSHA report, he calculated the average costs per exposed

worker of complying with OSHA’s proposed lead standard. The industries with the higher average compliance costs (primary smelting, secondary smelting, battery manufacturing, brass, bronze, and copper

foundries) tended to have higher employee exposures. The industries with lower average compliance

costs (newspapers, commercial printing, can manufacturing, gray iron foundries), whose costs were onetenth to one-twentieth those of the higher cost group, had a substantially lower proportion of overexposures. These results support the claim that employees tend to be protected from exposures when protection is cheap and overexposed when it is expensive.

Mendeloff reviewed the results of a number of recent inspections with OSHA inspectors. For firms

in violation of OSHA standards, the compliance officers estimated the costs of reaching compliance.

In some cases the compliance costs were modest, but for others, the costs were quite large. This group

of cases may not be a representative sample, but for most of them, the costs of compliance would be

substantially larger than both the average OSHA fine and the maximum OSHA penalty for serious violations ($1,000). Profit-maximizing businesses that take actions based on the “bottom line” will invest in health and safety only to the extent that such investments minimize their costs of doing business.

If compliance costs are substantially higher than expected penalties, the profit-maximizing firm will not

voluntarily udertake these health and safety investments.

Jones (237) examined OSHA inspection data for asbestos exposures from 1972 to 1979. She found

that an increase in engineering control costs of $l00 per employee was associated with an increase in

the average asbestos exposure level of 0.7 fibers per cubic centimeter , while an increase in OSHA penalties

of $350 per citation was associated with a decrease in average exposure level of 1 fiber per cubic centimeter. Thus employers appear to be sensitive to costs: as the costs of control go up, employers decide

not to implement controls (leading to higher worker exposure levels), while as the expected costs of OSHA

penalties go up, compliance improves. However, increased penalties were also associated with employers

more frequently deciding to contest the OSHA citations, again consistent with the theory that employer

decisions are sensitive to costs. Jones found that an increase in the total penalties of $1,000 was associated with a 27 percent increase in the probability that the employer would contest the results of the

inspection. <
322 Preventing Illness and Injury in the Workplace

SUMMARY

OTA has identified a number of incentives or

imperatives for the implementation of control

technologies. These include: voluntary efforts by

employers and voluntary associations, the availability of information, the desire to reduce insurance or workers’ compensation losses, fear of tort

liability actions, labor market pressures and collective bargaining agreements, and government

regulations. One or all of these may influence

employers to install and maintain appropriate

controls. However, all have significant limitations.

Management commitment has been called the

single most important ingredient in effective

health and safety programs. After being informed

of or discovering the existence of job hazards,

some employers will take action to reduce those

hazards, although the pressure of competition will

substantially limit these voluntary employer activities. In addition, employers and their employees

often participate in the development of voluntary

standards, which are an important source of information in the health and safety field. But because they are voluntary, these standards will

often have only a limited impact on worker health

and safety.

Making information about occupational hazards and their control available is a necessary first

step for many improvements in workplace health

and safety. Providing information through research and dissemination- is an important governmental activity. The increased availability of information on workplace hazards may serve as an

incentive for companies to introduce controls, but

it is not sufficient by itself to guarantee improvements in worker health and safety.

Employers may take actions to improve job

safety in order to reduce the costs of workers’

compensation and property insurance. The costs

of medical treatment and lost wages paid through

the workers’ compensation system provide a monetary incentive to reduce those injuries and illnesses. In addition, insurance companies and State

agencies that sell workers’ compensation insurance usually offer ‘loss-control services” to improve health and safety conditions in their client

companies. It is likely that workers’ compensation is an incentive for prevention of occupational

injuries, although data supporting this conclusion

are limited. For occupational illnesses, the economic incentive provided by workers’ compensation is reduced substantially because few cases of

work-related illnesses enter the workers’ compensation system. This appears to be true even for

well-studied occupational diseases, such as those

associated with asbestos and cotton dust.

By far the most common use of tort actions in

occupational safety and health are suits against

a third party—for example, against the manufacturer of products purchased by the employer for

use in the workplace. These suits may lead to improvements in working conditions, but a number

of factors limit their effectiveness. The first is that

suit cannot usually be brought against employers

because workers’ compensation laws bar employees from suing their employers in cases involving work-related disease and injury. Other limitations involve recognizing and proving causation,

and identifying the responsible manufacturers. It

is not now clear how important tort liability will

be as an incentive, although it has probably encouraged the development of substitutes for

asbestos.

To some extent, employers maybe motivated

to improve employee health and safety because

of pressures from the labor market. However, a

slack labor market, with relatively high unemployment, and other market imperfections limit

this incentive.

Negotiation and collective bargaining can also

bean incentive. Passage of the OSH Act in 1970

coincided with an increase in the number of contracts that included safety and health clauses, and

the clauses became increasingly specific. But this

is significantly limited because, first, only a small

percentage of U.S. workers belong to labor unions.

Second, not all unions have the kinds of expertise in industrial hygiene, injury prevention, or

occupational medicine needed to negotiate and enforce agreements concerning health and safety.

Third, by definition safety and health provisions

must compete for attention and resources with

other bargaining issues. Many workplaces have
.—

Ch. 15–incentives, Imperatives, and the Decision to Control ● 323

joint labor-management health and safety committees, but the research assessing the effectiveness of committees in improving worker health

and safety is limited.

The OSH Act itself created a number of opportunities for worker participation concerning occupational safety and health. For example, State

and local “right-to-know” laws and the OSHA

“hazard communication” standard will provide

workers with more information about hazards.

However, there is still controversy about the requirements of these regulations.

The final factor that influences employer decisions to control hazards is an imperative: the regulations and standards issued by government

agencies, mainly OSHA. In addition, some of the

regulatory actions of other Federal agencies may

require employer actions that either directly or

coincidentally improve worker health and safety.
16.

Economic Incentives,

Reindustrialization, and Federal

Assistance for Occupational Safety and

Health
and

. . . . . . . 337

.,
—

16 ■

Economic Incentives,

Reindustrialization, and Federal

Assistance for Occupational

Safety and Health

Economic incentives, tax programs, and finan- ble to integrate productivity-improving investcial assistance have all been suggested for stimu- ments in plant and equipment with the installation

lating improvements in occupational safety and of control technologies that safeguard worker

health, but have been little used in the United health and well-being. Finally, the Federal GovStates. In addition, the process of industrial ernment could also establish new programs for

change can itself be harnessed as a mechanism for financing research and training activities and for

improving occupational safety and health. Dur- assisting small businesses.

ing a time of reindustrialization, it may be possiECONOMIC INCENTIVES AND FINANCIAL ASSISTANCE

The general notion behind economic incentives

is to use the economic self-interests of individuals

and firms to accomplish social goals. For occupational health and safety, the aim is to set incentives so that employers, while seeking to earn

profits, will also prevent injuries and illnesses.

In theory the workers’ compensation system

provides an economic incentive for prevention,

but in practice it is limited, especially for illnesses

(see ch. 15). Another possible type of economic

incentive would substitute an injury tax or an exposure tax for traditional regulatory standards.

A third possibility involves the use of various governmental tax policies and financial assistance

programs.

Injury/Exposure Taxes

The idea an “injury tax” is generally wellreceived among economists as a substitute for

health and safety regulations (see, for example,

330,425,445,446). Although the idea has been criticized as politically infeasible (37,300), it has officially surfaced at least twice—in a draft 1976 report of the Council of Economic Advisers and in

a 1977 memo to President Carter from his chief

economic adviser, his budget director, and his domestic policy adviser. In both cases, union officials were outraged and the injury tax reference

was either deleted or suggested as a supplement,

not an alternative, that should be studied by an

interdepartmental task force (300). The task force

later rejected the injury tax approach (228).

As opposed to the regulatory system, which

penalizes firms for violations of regulations, an

injury tax system would levy direct financial penalties on firms for each injury. Firms would be

free to choose the least costly methods of accident prevention. Under certain assumptions, this

would be the most “cost effective” way to reduce

the number of injuries. Moreover, an injury tax

is appealing because it is directly related to safety

outcomes. (Similarly, it has been suggested that

effluent taxes or emission fees be used in the area

of environmental protection. See, for example,

251. )

The advocates of injury taxes believe them to

be better than regulatory standards, which are

considered inflexible and unnecessarily uniform

327
328 ● Preventing Illness and Injury in the Workplace

across firms and industries, not necessarily related

to workplace or work-force characteristics that

cause injuries, and not necessarily the least costly

way to reduce injuries (445,446). In addition, an

injury tax, if set at an appropriate level, might

provide employers with a stronger incentive to

prevent injuries than the current Occupational

Safety and Health Administration (OSHA) programs. It could also reward employers for efforts

to go beyond current regulatory standards, as well

as for conducting research on improved controls.

Smith (445,446) concluded that firms do respond to financial incentives and estimated the

effect that various levels of injury tax would have

on injury rates. To be effective, the taxes would

have to be fairly large. Using 1970 data on injuries, Smith estimated that a tax of $500 per injury would lead to a 2.2 to 3.2 percent reduction

in the disabling injury rate (injuries involving lost

work time as defined by standard Z-16 of the

American National Standards Institute). A tax of

$1,000 would reduce injuries 4.4 to 6.2 percent,

while one of $2,000 would reduce injuries 8.8 to

12.5 percent (446).

Although Smith suggests moderate fines for

each injury as a replacement for safety regulation,

he does not extend that approach to health regulation. Because occupational diseases often manifest themselves only after a latent period, there

would be considerable difficulty in determining

which of several employers was responsible for

the disease (446). Moreover, as discussed in chapters 2, 3, and 15, there are considerable difficulties

in distinguishing job-related diseases from nonoccupational ones.

Taxing hazardous exposure levels rather than

illnesses might be one possible way to affect jobrelated diseases. This could work like an effluent

or emission tax, under which firms pay a fixed

amount for each additional unit of pollution they

add to the water or air. Nichols and Zeckhauser

(330) have suggested such a tax on occupational

noise exposure. But Smith points out that enforcing an exposure tax approach would require a

“monumental inspection and monitoring program” (446). The attending administrative costs

would probably offset the advantages of such a

system. (To a limited extent, provisions of the

OSHA lead standard that require paying workers their usual wages if they must be removed

from lead-contaminated work areas have some

characteristics of an illness/exposure tax. )

An injury tax, even if limited to cases of acute

trauma, would encounter serious difficulties. The

first would be in setting an appropriate level for

the injury tax. Smith (445) estimated in 1970

dollars that a tax of $1,000 per disabling injury

would lead to a decline in injury rates of about

5 percent, while a $2,000 tax per injury would be

associated with a 10 percent decline. Adjusting

his estimates to account for inflation since 1970

yields injury taxes in the range of $2,500 to $5,000

(in 1983 dollars) per lost-workday injury to

achieve a 5 to 10 percent injury rate decline.1

Furthermore, if a tax for deaths or permanent

disabilities were set equal to the lost earnings of

the killed or disabled worker, it would be extremely high-ranging from tens of thousands to

hundreds of thousands of dollars. These values,

large as they are, do not include the psychic costs,

the pain and suffering associated with such injuries. To maximize the efficiency of the tax system it would be necessary to prohibit firms from

insuring themselves against these large losses to

ensure that firms would pay the full tax. But such

large penalties would generate considerable political opposition (64).

A second problem would be ensuring the accuracy of the injury records on which any tax

would be based. With a direct financial penalty

for each injury, employers have an incentive not

only to prevent injuries but also to underreport

them. (Ch. 2 and Working Paper #l discuss the

controversy about the accuracy of current employer-maintained records. ) Independent, firmby-firm audits to guarantee the accuracy of these

data would be quite expensive. Moreover, assessment of the results of an injury tax would be difficult because any declines in injury rates following implementation might represent decreased

reporting, not increased prevention (64). In some

cases there would also be problems in distinguish-

‘This approximate adjustment for the effects of inflation is based

on the two-and-a-half-fold increase in average hourly earnings from

1970 to 1983 and is consistent with the increases during that period

in the most commonly used price indexes (the Consumer Price Index, Producer Price Index, and Implicit Price Deflator for the Gross

National Product).
Ch. 16–Economic Incentives, Reindustrialization, and Federal Assistance for Occupational Safety and Health ● 329

ing occupational (and taxable) injuries from nonoccupational ones. These would include many

sprains and strains, as well as many injuries to

the back.

Third, an injury tax might increase the level of

controversy in this field. Boden and Wegman (64)

argue that it would be politically feasible only for

the less severe injuries. Mendeloff (300) suggests

that even a tax of $250 per injury might be more

expensive to firms than current OSHA safety

standards. In theory, an injury tax should apply

to all injuries. But in practice, there would be controversies concerning application of an injury tax

in cases of claimed “employee misconduct. ”

Fourth, the operation of such a system would

be relatively invisible to workers. Employers

would calculate the number of injuries and send

the Government a check (64). If an injury tax system replaced existing standards, and suspended

unannounced inspections and workers’ rights to

request “complaint inspections, ” it would change

dramatically the worker and governmental roles

in solving health and safety problems.

Fifth, an injury tax might create an incentive

for larger firms to subcontract dangerous jobs to

smaller, less financially solvent firms that lack the

resources to prevent injuries as well as to pay the

injury tax. An injury tax might also lead to changes

in employment policies, for example, in hiring and

firing decisions. The effectiveness of these policies

in reducing injuries has been questioned (64) (see

also ch. 4), and such a response by employers may

have other social and economic implications that

would need to be considered.

Finally, injury taxes have been criticized on

ethical grounds. It has been asserted that such a

tax would be a “license to maim” or a “license to

kill.” By providing a system of “taxes” and “licenses, ” society would seem to be saying that it

is all right for a certain number of occupational

deaths and injuries to occur. But if an injury tax

reduced injuries while preserving other social

values, it would probably be considered an advance because fewer workers were being harmed,

The operation of an injury tax would also lead

to variations in the level of protection that depended on the costs of prevention. Workers in industries facing low prevention costs would have

safer jobs than those in industries with high prevention costs. Job risks would thus remain unequally distributed. This, however, runs counter

to a commitment to the goal of equal protection

for all (277).

Tax Programs and Financial Assistance

When the topic of economic incentives is raised,

most employers think of changing the taxes they

are most familiar with—the business income tax

system. Congress could modify the structure of

business taxes to encourage investment in health

and safety control technologies or could assist

businesses in financing such investments.

A congressional decision to modify the tax

structure or provide financial assistance can be

thought of as providing some level of “social funding” for investments in occupational safety and

health. The general rationale for this is to reduce

the costs of health and safety investments, thus

encouraging firms to undertake them. Burstein

(531) states that tax policy can be used to lower

business taxes on certain kinds of investments,

thereby increasing the returns to business “to reflect the external benefits provided by the activity.” These external economic benefits, such as

reductions in the cost of medical care due to improvements in employee health, are ones that individual firms would not ordinarily receive because companies do not shoulder all the costs of

ill health. Some of those costs are borne by employees, by other insurance policyholders, and by

the Government. Tax policy might be used to

reward the individual firm for actions that reduce

these “social costs, ”

Many believe that society ought to assist businesses in meeting certain social goals, such as reducing pollution or improving worker health and

safety. This is especially true when, for various

reasons, society changes the goals by, for example, increasing the stringency of applicable regulations. Thus these tax and financial assistance

programs lead to subsidies for businesses, but this

may be appropriate to reach socially valued goals

of environmental and worker protection.

Four kinds of programs are of interest: investment tax credits, accelerated depreciation, Government loan programs, and direct subsidies. All
330 ● Preventing Illness and Injury in the Workplace

have already been used in the area of environmental protection and loan programs have been

used, to a limited extent, for occupational safety

and health.

An investment tax credit allows a business to

apply a certain percentage of the purchase price

of a capital good directly against the taxes owed

by the firm, in addition to the normal depreciation of the investment over time. When firms have

been allowed such credits, some of the investments may have included controls for workplace

hazards or pollution. However, Federal tax policies have not created an investment tax credit

especially for employee health and safety investments, although such credits have been proposed.

Accelerated depreciation or rapid amortization

of investments is a second tax subsidy mechanism.

This permits businesses to write off the costs of

an investment more rapidly than the normal depreciation rules would allow. Federal tax law has

allowed 5-year amortization of pollution control

equipment (651). This accelerated depreciation for

assets that will last longer than 5 years has been

permitted only for investments that lead to pollution control without also creating “significant”

changes in other aspects of the facility. It has not,

however, been available for investments to protect worker health and safety (31).

A proposal to allow accelerated depreciation

for OSHA-mandated investments moved through

the legislative process to the conference committee stage in 1978. A compromise reached in conference was to request a Treasury Department feasibility study of such a change in the tax law (228).

(The major conclusions of that study are discussed

later in this section.)

A third kind of Government program is to provide financial assistance, either directly or indirectly. Financial assistance is defined here to

mean programs that provide loans or other types

of financing (such as bonds) to assist businesses

in paying for health and safety investments. Businesses must repay the loans or bonds, but the cost

of these obligations is often partially subsidized

and they provide a source of capital for investments that may not return a profit to the firm.

Private lenders are often reluctant to loan money

for such “nonproductive” investments so, it is

argued, the Government has a role in providing

such financing.

Financial assistance can take a number of forms,

including Government guarantees of private

loans, Government interest subsidies for private

loans, direct Government loans (often at reduced

interest rates), and the use of tax-exempt financing by private firms. In loan guarantee programs,

the Government promises to repay a private loan

if the borrower defaults. This can be combined

with interest subsidies, under which the Government pays a share of the interest costs. Under direct loan programs, the Government acts as if it

were a bank and loans the money directly at market interest rates or at a lower, subsidized rate.

Tax-exempt financing allows private business to

take advantage of the lower interest rates on

bonds issued by States and local governments.

When Congress passed the Occupational Safety

and Health (OSH) Act in 1970 it concluded that

the burdens of compliance would often disproportionately affect small businesses. Rather than exempt such firms from the requirements of the act,

Congress chose to amend section 7(b) of the Small

Business Act to allow the Small Business Administration (SBA) to make or guarantee loans for

OSHA compliance expenditures. The requirements were, first, that the expenditures must be

to comply with OSHA regulations and, second,

that the small business was “likely to suffer substantial economic injury” without such assistance

(OSH Act).

From September 1971 to August 1981, the SBA

processed 261 OSHA-related loans for $72.8 million—about 26 loans per year, each averaging

about $280,000. In fiscal year 1981, 9 loans were

made for a total of $7.1 million.

These loans constituted a very small part of

SBA loans. Although exact figures are not readily

available, in recent years the agency has been

making or guaranteeing between 20,000 and

30,000 loans annually for between $2.5 billion to

$4 billion. It is possible that some firms have used

regular SBA loans to finance OSHA compliance

expenditures in addition to other investments, The

dedicated OSHA loans, however, usually carried

a lower interest rate than the regular loan program (233).
—— ——

Ch. 16—Economic Incentives, Reindustrialization, and Federal Assistance for Occupational Safety and Health . 331

The OSHA loans program, as well as the SBA

loans for pollution control, were eliminated by

the Omnibus Budget Reconciliation Act of 1981

(Public Law 97-35, Section 1905). It is not clear

how effective this loan program was in improving

health and safety in the handful of firms that received loans. In 1979, the General Accounting Office (GAO) criticized the program, in part because

few loans had been made. In addition, GAO concluded, after an examination of SBA files concerning a sample of loans, that it was not clear that

the loans had been granted only to businesses that

needed the loans or that the use of the loans actually resulted in the elimination of workplace

hazards (509).

Tax-exempt bonds, issued by State or local governments to provide financing for private firms,

are backed by the credit of the borrowing firm,

the revenue from the project financed, or the value

of the facility. Defaults are borne by those who

hold the bonds, not the State or local government

that issued them. Because the interest on such

bonds is exempt from Federal income taxes,

lenders are willing to accept lower interest rates.

Thus, private firms that use these bonds are able

to finance investments at interest rates lower than

they would otherwise pay. In 1968, Congress

limited the use of bonds that exceeded a certain

size to those that finance pollution control and

certain public facilities (such as airports, convention centers, parking garages, sports stadiums,

etc. ) (492).

The Internal Revenue Service (IRS) has had difficulty in administering this provision of the tax

code. More than 6 years passed before it published

temporary regulations, and they encountered difficulties in ensuring that this financing is limited

to pollution control and is not used by firms for

“productive investments” (651). The IRS has

tended to limit “pollution control” to certain “endof-pipe” technologies that have no productive

value, such as effluent water treatment. More fundamental process changes that also reduce the

amount of pollution have generally not qualified

for tax-exempt financing (538). The IRS has also

disallowed tax-exempt financing for containment

devices for nuclear power plants, as well as spending for the disposal of hazardous wastes, because

these were considered to be normal expenses for

plant operations, not extra costs due to pollution

control requirements.

Despite these restrictions, it has been estimated

that about 48 percent of all capital spending for

pollution control has been financed with taxexempt bonds (538). However, the IRS has not

allowed tax-free financing for investments that

protect employees from toxic substance exposure

in addition to preventing environmental damage,

apparently on the belief that the company would

have invested in worker protection in any case

as part of a prudent personnel policy (651). In the

last few years, Congress has also enacted several

restrictions on the amount of tax-free financing

that can be issued by State and local governments

to private businesses.

Finally, the Government could assist businesses

by giving them direct subsidies or grants. Economists generally prefer direct subsidies to indirect

tax subsidies or loan programs because they create

fewer market distortions, are simpler for the IRS

to administer, and can often be more cost effective. Direct grants do, however, enter directly into

the appropriations process and thus may be more

visible and hence more difficult to legislate. Moreover, a firm will probably incur a greater paperwork burden while applying for a direct grant

than it would with an indirect tax subsidy.

As noted earlier, in the Revenue Act of 1978,

Congress requested the Department of the Treasury to study the feasibility of tax incentives for

occupational health and safety spending. The report, written by the Office of Tax Analysis of the

Treasury Department and published in January

1981, was very critical of tax subsidies for OSHA

and Mine Safety and Health Administration

(MSHA) compliance. It noted that such a subsidy

program would be difficult to administer, mostly

because of problems in distinguishing health and

safety expenditures from normal business costs.

Second, the Treasury Department analysis expressed concern that subsidies for capital costs

only would encourage firms to adopt unnecessarily capital-intensive compliance methods.

Third, they criticized special investment tax credits, accelerated depreciation, and tax-exempt

financing on several more technical grounds, including the differential treatment of assets with
332 ● Preventing Illness and Injury in the Workplace

different lifetimes, the differential advantage incurred by profitable (as opposed to unprofitable)

firms and by capital-intensive (versus labor-intensive) companies, and the large benefit that taxexempt financing gives to upper-income bondholders (651).

The Interagency Task Force had previously examined the issue of direct economic incentives.

In contrast to the negative comments by the Treasury Department report, they recommended, if

general economic conditions permitted, both the

extension of the investment tax credit to noncapital expenditures for health and safety investments

and the creation of a program of direct financial

assistance. This should, they suggested, take the

form of a direct subsidy rather than a tax credit.

The subsidy would be limited to high-hazard firms

within hazardous industries, and would only apply to the firm’s health and safety spending that

represented an increase over their spending in a

baseline year. The program could be administered

either through the Treasury Department or through

the regulatory agencies (OSHA and MSHA) (228).

To date, these recommendations concerning financial assistance have not been acted upon.

OTA concludes that the use of tax incentives

and financial assistance programs might spur the

implementation of controls, assist businesses in

compliance, and possibly reduce the controversy

of regulatory proceedings because of the availability of sources of finance. However, there are several disadvantages.

First, they would represent either a reduction

in Federal tax revenues or an increase in budget

outlays. Second, a tax incentive program would

also tend to increase the complexity of the tax law,

while a direct assistance program would require

personnel and resources for program administration. Third, these programs will often provide financial benefits to firms that would have installed

controls even in the absence of a subsidy program.

Fourth, there would be difficulties in dividing the

purchase price of equipment between features that

are health and safety controls and those that are

normally part of the equipment for purely productive reasons. Finally, each of these programs

has its own limitations, and would have differing effects on other aspects of business investment

behavior, as well as on the distribution of wealth,

income, and the burden of income taxes. All of

these would need to be considered before establishing any program.

REINDUSTRIALIZATION AND OCCUPATIONAL SAFETY AND HEALTH

Some recent discussions of the U.S. economy

have included references to “reindustrialization”

and “industrial policy. ” Commentators have generally focused on the international competitiveness of certain U.S. industries—principally in

manufacturing. Little of the discussion has been

about occupational health and safety policy or

even about regulation. But many proponents talk

about using economic incentives—including tax

law changes and Government financing—to implement the new policies. Moreover, some have

suggested changes in health and safety regulations

in order to facilitate business reinvestment and

plant modernization.

OTA considers the reindustrialization debate

to be relevant to this report for two reasons. First,

reindustrialization policies might have either a

beneficial or an adverse impact on worker health

and safety. Second, if the Federal Government

stimulates economic revitalization through tax,

expenditure, or financing programs, it may be

advantageous to incorporate health and safety

considerations into those policies. OTA, in this

assessment, is not advocating any form of industrial policy. Indeed, industrial policies and more

general economic policies are areas beyond the

scope of this report. But there do appear to be

connections between these policies and possibilities for improving the implementation of control

technologies.

Reindustrialization and Industrial Policy

The terms reindustrialization and industrial policy often have meaning only in the eye of the
— -————

Ch. 16–Economic Incentives, ReindustrializafionJ and Federal Assistance for Occupational Safety and Health ● 333

beholder. An enormous range of suggestions concerning U.S. economic productivity and international competitiveness have been made under

these labels (528). Some think the problem is that

the Government has interfered too much in the

market through existing tax and regulatory policies. The solution they propose is to reduce the

size of Government and limit its intervention to

providing certain “public goods,” such as national

defense. Others think that economic revitalization can best be achieved by shifting Government

policies. These commentators want policies that

increase incentives to work and save and that reduce incentives to consume. Specifically, they

have advocated across-the-board changes in business tax laws to encourage investment. Some of

these suggestions were legislated in the Economic

Recovery Tax Act of 1981.

Still another group wants to see explicit Federal policies that will encourage the growth of

“sunrise” industries and that will ameliorate or

prevent the decline of “sunset” industries. Critics

of this position question whether the Government

can correctly identify sunrise and sunset industries and some wonder if this is an appropriate

role for Government at all. (See 493 and 528 for

a discussion of these views. )

All three groups are attempting to create conditions that will lead to economic revitalization,

but generally only the third group is advocating

selective or targeted industrial policies. These

analysts differ in their explanations of what has

gone wrong and in their prescriptions for new policies and institutional arrangements. (Some of the

leading advocates of industrial policies include

Reich (383,384), Magaziner and Reich (283),

Rohatyn (395), Bluestone and Harrison (62), and

Etzioni (167). For contrasting views, see, for example, Economic Report of the President (169)

and Schultze (426). )

The Congressional Budget Office (CBO) has

outlined three major strategies that have been proposed as alternative industrial policies. The first

is to work with current policy instruments and

rely on economic recovery and private-market adjustments to solve existing problems. A second

strategy is to “modernize existing policies . . . that

may now have become impediments to growth

and efficiency, “ including changes in antitrust and

trade policy, as well as programs to assist dislocated workers, and changes in regulatory policy

that would assist businesses in achieving economic

growth (493).

A third strategy for industrial policy would involve the creation of new institutions, among

which could be an information and/or consensus development agency, an executive branch coordinating agency, and a Government financial

institution. An information/consensus agency

could gather, synthesize, and disseminate information on American industry, including assessments of U.S. Government policies and of foreign activities. Several proposals would also

include creation of a council, composed of representatives from business, labor, and Government, to develop a consensus on the goals of an

industrial policy. An executive branch coordinating agency could attempt to coordinate the policies of the Federal Government toward a particular industry or group of industries, in order to

encourage growth and competitiveness. The proposed Government financial institution would be

a national industrial development bank or several regional development banks, often modeled

after the Depression-era Reconstruction Finance

Corporation (493,527).

As noted, environmental regulation and workplace health and safety regulation have received

little attention in this debate. Magaziner and Reich

(283), for example, devote only one paragraph to

the issue. In it they call for regulations that apply

to “emerging” industries that are “harmonized as

far as possible with the needs and requirements

of other nations. “ “Declining” industries, on the

other hand, “should only be required to meet

standards that are appropriate to the remaining

useful life of the industry. ” Bluestone and Harrison (62) note that reindustrialization should be

directed toward several goals, including the creation of safer work environments, but they do not

elaborate on this point.

Some discussions of industrial policy have,

however, advocated the relaxation of environmental and occupational safety and health regulations as part of a plan for industrial modernization. For example, Etzioni (166) has suggested
334 ● Preventing Illness and Injury in the Workplace

that the United States must choose whether reindustrialization or improvements in the “quality

of life” will be made the Nation’s “top priority. ”

These discussions assume that Federal regulations

have seriously hampered the growth of the U.S.

economy and improvements in productivity and

international competitiveness. However, as discussed later in this chapter, the adverse impact

on productivity of occupational health and safety

regulation is actually fairly small. Moreover, in

some cases OSHA regulation has played a role

in inducing or facilitating several industrial innovations that improved both health and safety, as

well as productivity.

OTA analyzed the role of technology in international competitiveness in a 1980 assessment on

technology and the steel industry and in a 1981

report comparing the competitiveness of three

industries—steel, electronics, and automobiles.

These reports examined the general issues of technology and productivity in these industries, including the effects of regulatory policies. In the

case of steel, OTA found that several major new

steelmaking processes are not only more efficient,

but also create less pollution. Moreover, modest

technological improvements have resulted from

the “push” provided by health and safety, and by

environmental regulations, including improved

emissions controls and better door seals for coke

ovens (538). More generally, the 1980 report outlined a number of policy options.

The most critical policy option may be that of

a governmental steel industry sector policy, that

is, for a coherent set of specific policies designed

to achieve prescribed goals. , . . The lack of a sector policy and the designation of a lead agency

to implement such a policy has led to policies that

often conflict with one another, create an adversarial relationship between Government and industry, and fail to address critical issues.

In its comparison of the competitiveness of

steel, electronics, and automobiles, OTA outlined

two prerequisites for industrial policy (543):

mechanisms for reaching agreement on objectives that are acceptable to Government and

various interest groups; and

improved analytical capability on the part of

Government agencies concerned with economic efficiency and competitiveness.

In addition to taxation and spending policies,

Congress and the executive branch have already

created programs that might be considered forms

of industrial policy and have considered others.

For example, there are already a large number of

Federal programs that provide grants, loans, loan

guarantees, and economic assistance for various

purposes (512,529).

The Steel Tripartite Advisory Committee,

appointed by President Carter, consisted of representatives from Government, labor, and business who discussed issues concerning modernization of the U.S. steel industry. Among other

recommendations, they suggested delays in several environmental protection requirements in order to facilitate plant modernization (458). In

1981, Congress enacted the Steel Compliance Act,

which postponed certain deadlines of the Clean

Air Act for the steel industry.

Finally, a number of bills have been introduced

in recent sessions of Congress concerning industrial policy (see 534). Hearings have been held on

some of the topics addressed by these bills (513,

515,525,534,549).

Reindustrialization and Occupational

Health and Safety

The continuous process of industrial change (including the replacement of plant and equipment)

can lead to safer and more healthful workplaces.

In fact, a large portion of the improvements in

worker health and safety during this century may

not have been the result of conscious decisions

to add controls to existing processes, but may

have occurred coincidentally as new technologies,

new processes, and new industries were introduced. Unfortunately, it is extremely difficult to

gather definitive data on this question.

Industrial and other policies that facilitate the

process of industrial change might simultaneously

improve occupational safety and health. Moreover, regulations can have a favorable impact on

the productive efficiency of an industry either because they directly spur innovations and changes

or because they provide an opportunity to change

productive aspects of plant operations. But there

is some danger that combining policies that are
Ch. 16–Economic Incentives, Reindustrialization, and federal Assistance for Occupational Safety and Health 335

designed to improve productivity with those that

address employee health and safety will lead to

an emphasis on the former at the expense of the

latter.

Industrial change does not automatically improve worker health and safety, nor are new

plants necessarily safer than old ones. What is true

is that it is generally cheaper and more effective

to control any given health and safety hazard

when constructing new plant and equipment than

it is to retrofit existing plant and equipment (see

box U).

By stimulating changes in plant and equipment

for productivity reasons, new industrial policies

may also present an opportunity to improve

worker health and safety. The various tax incentives, loan guarantees, and other subsidies that

have been suggested to improve industrial competitiveness might also be used as incentives for

health and safety improvements. Such policies can

thus make compliance with health and safety regulations easier. In addition, if desired, the opportunity presented by reindustrialization could be

used to achieve greater levels of protection.

It has been argued that health and safety regulation has hampered economic productivity by requiring expenditures for control technologies that

are “nonproductive. ” Money spent for controls

could have been invested in improving plant proBox U.—The Costs of Add-On and New Process Controls

It is widely believed, indeed it is pretty much common sense, that controls are cheaper and more

effective when designed into new plants than when added or retrofitted. Nearly every control that could

be included as a retrofit could also be included in the design stage. There is no reason to believe that

it would cost more to purchase a control for a new plant of the same size with the same hazard than

it would be to buy the control for an older plant,

Second, in designing the new plant, the architects, designers, and engineers have a greater opportunity to make sure that everything “fits together.” For example, ventilation systems can be designed

efficiently rather than having to wind their way around existing equipment, building structures, or other

duct work. Work stations and tasks can be designed with ergonomics in mind (see ch. 7) to enhance

worker productivity and to be less stressful. Thus the design can improve a number of different features,

including employee health and safety.

Third, installing retrofit controls always involves disruptions-cutting through existing equipment,

temporarily closing down portions of the plant (or paying overtime rates to have the work done on

weekends or at night), or taking machinery apart-that can be very costly. Fourth, retrofit controls can

easily outlive the rest of the plant and equipment, especially in older facilities. Thus the plant’s life may

end before the firm has reaped the full life of the control devices. For some devices there will be a salvage

market, but for many there will not.

OTA has found several examples to support this reasoning. Rollover protection for mining vehicles

is more expensive when retrofitted than when purchased on new equipment (248). In the OSHA vinyl

chloride rulemaking hearings, the Firestone Plastics Co. estimated that reaching a 100 parts per million

standard would cost 34 percent more in a 25-year-old plant than in an 8-year-old one; meeting a 10

parts per million standard would cost twice as much in the older plant (38). Swedish research in the

1960s led to “designed-in” noise control for one company that cost only a fraction of what retrofit controls would have cost (228).

Direct comparisons of the costs of control in new plants versus retrofitting old plants are often difficult, however, because other relevant variables change. For example, the new plant may be larger or

have a different production process. A comparison of the experience of two plants in controlling radiation exposures illustrates this. Retrofitting an old uranium processing plant to meet new, more stringent

radiation exposure standards cost approximately 30 percent as much as the original total cost of the

plant. Later a new plant was built to meet the same radiation standards. The control costs for this plant

amounted to only 8 percent of the new construction costs. But there were confounding variables: the

new plant was larger and had at least one significantly different type of process equipment (97).
336 ● Preventing Illness and Injury in the Workplace

ductivity. In the aggregate, however, this diversion is relatively small. Employee health and

safety regulations have been estimated as having

led to a 0.4 percent decline in traditional measures of productivity (137). Of course, these measurements do not capture any of the health and

safety benefits of regulation (see additional discussion in ch. 13).

But compliance with regulations can also provide an opportunity to make changes that improve plant productivity. As one group of analysts has noted, “[b]ecause it is less expensive and

disruptive to make multiple changes simultaneously, rather than individually, businessmen naturally take the opportunity of regulation to introduce other improvements” (31). (See 228 for several examples for which productivity improvements occurred at the same time as health and

safety improvements. )

According to several studies, regulation can

stimulate new research or, more likely, speed up

the tempo of existing research. One group of researchers reports that 33 percent of their study’s

respondents indicated process improvements spurred

by regulatory changes (231), while two other

studies reported similar conclusions (70,101). In

a five-country comparison of Government activities that affected innovation, the researchers concluded that regulatory requirements concerning

environmental protection “may be more important” for inducing innovation than other programs

that were designed explicitly to influence the innovation process (29).

Ruttenberg (412) has pointed out a number of

instances in which regulation has been a stimulus

for new markets, new jobs, and basic product and

process innovation. “To a surprising degree, regulation is the mother of invention, ” she noted.

This occurs because in redesigning products and

processes to comply with health, safety, and environmental regulations, companies often fundamentally redesign the product or process through

the use of new technology. Second, the existence

of Government standards creates “assured markets” for the results of the research efforts.

In the OSHA arena, the stimulus of the vinyl

chloride regulation accelerated a then-developing

improvement in polymerization technology. Some

of the controls that were applied to reduce vinyl

chloride exposures also increased production efficiency. (See box N in ch. 12. )

Ruttenberg’s case study of the OSHA cotton

dust standard, commissioned for this assessment,

reveals a similar phenomenon. Although a direct

cause-and-effect relationship is difficult to prove,

it seems clear that the recent modernization of the

American textile industry was at least accelerated

by the OSHA cotton dust standard. Compliance

with the standard involved, in large part, the installation of new and more productive capital

equipment. Some “nonproductive” investments

(such as for additional ventilation) have been required, but process and equipment changes included in new designs have substantially lowered

cotton dust levels. This new equipment is also

more productive because it consolidates several

previously separate processes, reduces energy consumption, operates faster, and produces cloth of

improved quality. Although the new technology

has some limitations, the textile industry has been

able to raise productivity and improve worker

health and safety at the same time (413).

A recent report to OSHA concerning the costs

of complying with the lead standard discusses the

potential for new technology simultaneously reducing worker exposures, reducing the costs of

controlling exposures, and improving productivity in a primary lead smelter (see box V). It must

be noted that this technology has not yet been implemented on a large scale and there are uncertainties about its adoption. But what is not seriously questioned is that process redesign is the

most effective way of achieving both productivity

and employee health and safety goals.

As previously noted, industrial policies would

require not only agreement among the affected

parties, but also analytical capability. The National Institute for Occupational Safety and

Health (NIOSH) and the Environmental Protection Agency have developed a methodology for

industry-specific research planning (220). The general objectives of this work were to improve the

coordination of environmental and occupational

regulations and to identify health and environmental problems and solutions at an early stage.

Although the focus of this project was research
— -..

Ch. 16–Economic Incentives, Reindustrialization, and Federal Assistance for Occupational Safety and Health “ 337

Box V.—Reducing Lead Exposures: Add-on Controls v. New Processes

The OSHA lead standard sets a limit for occupational lead exposures at 50 micrograms of

lead per cubic meter of air (50 micrograms/m3

).

In a study done for OSHA, Charles River Associates (103) (discussed by Gobel, Hattis, et al.

(184)) examined work exposures and controls in

a primary lead smelter with an annual capacity

of 225,000 tons. The highest exposures, considering both the number of workers exposed and

the exposure levels, occurred in two departments-the sinter plant and the blast furnace

area. The Charles River Associates report compared the costs and emission reductions expected

from using each of two methods of moving toward

compliance with the lead standard.

The first method considered was conventional

“add-on” or “end-of-pipe” control technology.

None of the manufacturing process would be

changed, and no new production equipment

would be installed. Instead, enclosure and ventilation systems would be added to separate

workers from airborne lead or to dilute it to

acceptable levels. The second method considered

a number of new technologies, which involved

new production machinery, to smelt lead. Installing new production machinery would reduce

worker exposures more than add-on controls

would, and the new machinery also achieves

some savings in labor and materials costs and an

increase in income from the sale of sulfuric acid

(a byproduct of lead smelting). But at the same

time, the capital costs of new production machinery are higher (table 16-1).

The difference in costs might be reduced by

current tax preferences for investments. Investment tax credits and rules concerning depreciation for capital investments might offset mom of

the costs of new machinery than of add-on controls, but the quantitative impact of those preferences was not calculated. Moreover, changes

in the tax laws to encourage health and safety

investments might have an additional effect.

If a new smelter is to be constructed, both

health and economic considerations would favor

the new Machinery. Its construction cost and the

cost of a conventional smelter would be similar,

and its reduced emissions and reduced operating costs would sway the decision. But installing the new process in an existing smelter, given

the economic factors, would require a card

weighing of tax advantages and the other capital and operating costs.
338 ● Preventing Illness and Injury in the Workplace

planning for two agencies, the general idea could

be extended to other Federal financial and regulatory policies. In particular, the methodology follows the industry breakdown used in the Commerce Department’s annual report, U.S. Industrial

Outlook, and develops a series of indicators that

could be used to coordinate Federal policies.

A Federal Interagency Task Force on Workplace Safety and Health recommended in 1978

that OSHA take steps to identify hazards for

which engineering controls could be installed

along with the normal replacement of plant and

equipment (228). Both types of analytical work

might be usefully considered in developing industrial policies.

OSHA regulations can also be designed to consider the capital and investment cycles of plants

and firms. To some extent, the use of delayed implementation schedules takes these concerns into

account. Industries then have some flexibility concerning the timing of engineering controls. Feasibility is an important consideration in such cases:

something that may not be feasible in 6 months

may be feasible ins years. One suggestion, made

in the OSHA proceeding concerning noise exposure rulemaking, is the possibility of different permissible exposure limits for new and old plants.

Such “grandfathering” may ease the compliance

burden in old plants but needs to be done cautiously lest it create an unwanted incentive for

continuing the operation of inefficient, older

plants. In addition, it tends to create two classes

of protection, with workers in new plants being

protected more than workers in older facilities.

As described in chapter 1, this assessment suggests several options related to occupational

health and safety, industrial policies, and reindustrialization. First, if funds or tax incentives are

created for the building or rebuilding of industry, applications for those benefits might be required to include a discussion of methods to be

used to control expected health and safety hazards. These funds could be extended to expenditures for control technologies to reduce those

hazards. Second, companies receiving reindustrialization assistance might be required to design

health and safety into their new plant and equipment, either to meet existing health and safety

standards, or to achieve lower exposure levels or

safer processes.

Two other options consider the relationship between OSHA regulatory actions and reindustrialization. Because of the potential for improving

health and safety, as well as productivity, during the process of modernization, OSHA regulatory actions could consider explicitly the capital

and investment cycles of plants, firms, and industries. Information could be developed concerning the health, safety, investment, and productivity needs of various industries. In particular,

if studies show that an industry is going to make

major changes to improve productivity, OSHA

might consider delaying the required attainment

of a standard through engineering means until the

modernization is undertaken. Alternatively,

OSHA regulations might be used to spur the development of new technologies and accelerate the

process of industrial change. The history of

OSHA’s vinyl chloride and cotton dust regulations shows that, at least in some cases, employer

efforts to comply with health and safety standards can also be associated with productivity improvements.

FEDERAL AID FOR RESEARCH AND INFORMATION DISSEMINATION

Creation of an Occupational cently. Funding has been reduced for two areas

Safety and Health Fund in particular—education and training programs,

and research on workplace illnesses and injuries.

The advisory panel to this assessment expressed One way to provide for more stable and enhanced

concern about the large swings in occupational funding would be to establish an Occupational

safety and health policy that have occurred re- Safety and Health Fund. This fund might also pro-
Ch. 16—Economic incentives, Reindustrialization, and Federal Assistance for Occupational Safety and Health ● 339

vide a focus for the enhanced efforts in control

technology research, education and training, and

information dissemination.

The Work Environment Fund of Sweden offers

a possible model for a U.S. fund (468). Sweden,

partly because of its commitment to providing extensive education and training, as well as funding for research on hazards and controls, is viewed

by many as an international leader in occupational safety and health. Two organizations are

particularly responsible for these activities. The

first is the Work Environment Fund itself, established in 1972, which is funded by a payroll tax

on employers of 0.155 percent. The fund is administered, in typically Swedish fashion, by a tripartite board composed of representatives of management, labor, and Government.

In its first 10 years, over 1,800 research and

development projects and about 1,500 for training and information were funded. The research

and development grants have included funding

of epidemiological and toxicological studies,

measurement techniques, and development of

control techniques for a variety of hazards. In recent years, these have focused on the hazards of

working with various chemicals, including solvents, metals, minerals, welding and cutting products, and rubber and plastics. The fund has also

sponsored work on physical agents, including

noise, vibration, radiation, and in issues concerning ergonomic design related to working postures

and lifting requirements (468).

The training and information projects have included the development of course materials for

the introductory and advanced training of worker

safety stewards and supervisors. From 1972 to

1981, nearly 400,000 individuals received some

form of training. The Joint Industrial Council,

which was created by an agreement of Swedish

employers and unions in the 1940s, has produced

most of the educational materials concerning

workplace health and safety used for this training (468).

There are only a few U.S. examples of cooperative labor-management-Government research

and training activities related to health and safety.

One example is a set of experiments concerning

the use of “washed cotton” to control the hazards

of cotton dust. This project is funded by both

Government and industry, with oversight and direction provided by a group of labor, management, and Government officials. There have also

been jointly administered research efforts and

training programs that have resulted from collective bargaining.

Congress could consider several possible administrative arrangements if it created a fund. It could

follow the Swedish model by creating a tripartite board to administer this fund, or it could delegate administrative responsibilities to NIOSH or

OSHA. It could create this fund and its research

and training projects to exist alongside the existing

projects and arrangements at OSHA and NIOSH,

or it could consolidate with this fund all existing

research and training, including NIOSH extramural research grants, NIOSH training grants,

OSHA New Directions grants, and OSHA-funded

consultation.

Financing could be through a payroll tax on

employers or through a tax or surcharge based

on the level of workers’ compensation premiums

paid by employers (with some adjustments for the

presence of health hazards in various industries).

For example a 0.1 percent employer tax on the

total U.S. payroll of $1.6 trillion (in 1982) would

result in annual revenues of about $1.6 billion.

A payroll tax of 0.01 percent would raise $160

million. A 1.0 percent surcharge on workers’ compensation premiums (about $25 billion in 1980)

would produce annual revenues of $250 million.

Assessments for health, safety, and environmental activities have been used in the United

States in at least two cases. The Comprehensive

Environmental Response, Compensation, and Liability Act of 1980 created a “superfund” to pay

for activities related to releases of hazardous

wastes. Most of the funding for this is from taxes

on oil and chemicals (546). The recently enacted

right-to-know law in the State of Washington includes an assessment of 75 cents for each employee

in the State, to be paid by employers (351). One

bill concerning asbestos compensation, now under

congressional consideration, proposes establishing an assessment to be used for research (517).

Although creation of an Occupational Safety

and Health Fund would enhance the commitment
340 . Preventing Illness and Injury in the Workplace

to research and training in this area, there are disadvantages to consider. The relationship between

this fund and the existing agencies (OSHA and

NIOSH) would need to be determined. Moreover,

a new tax or surcharge, even though one of modest size, runs against recent reductions in business

taxes.

Federal Assistance to Small Businesses

Improvements in employee health and safety

can be difficult for smaller businesses, which often

lack technical expertise in industrial hygiene,

safety engineering, and occupational medicine.

Smaller businesses commonly face financial difficulties as well.

As discussed above, from 1971 to 1981, the

Small Business Administration issued a limited

number of loans to assist small businesses in complying with OSHA standards. In 1981 Congress

eliminated authorization for this program. One

option would be to study the results of this loan

program, especially to learn why it was used so

infrequently. After such a study, Congress could

consider reauthorizing the loan program and providing an adequate level of funding.

Other kinds of Federal assistance for small business could include providing technical assistance

and facilitating the creation of programs to provide technical assistance. Chapter 12 discusses

OSHA consultation, which is the major OSHA

activity for providing assistance to small businesses.

SUMMARY

Several approaches to improving occupational

safety and health have not been extensively used

in the United States. These include the use of economic incentives, tax incentives, and financial

assistance. Although in theory the workers’ compensation system provides an economic incentive

to prevent worker injuries and illnesses, in practice it provides only a limited economic incentive

for prevention, especially for occupational illnesses.

Another possible type of economic incentive involves injury or exposure taxes. As a substitute

NIOSH and OSHA could also encourage the

development of programs to provide industrial

hygiene, safety engineering, medical surveillance,

and worker health and safety training. These

could be established to service industries, regions,

and employers who do not offer such services.

Especially helpful would be programs for servicing small businesses in particular areas.

Because it is inefficient and impractical to require each small business to provide a full range

of safety and health services, programs to provide shared resources might be cost effective. Federal funding could be used to start such programs.

However, there may be difficulties in sustaining

these programs after the startup period. Even

though the price of shared programs should be

less than if a company were to purchase the services entirely on its own, some small businesses

might find it beyond their means. The steps that

are needed to aid those companies are not addressed by providing shared resources.

As discussed in chapter 15, the regulation of

the products purchased by small businesses may

also be a way of improving, to some extent, the

health and safety of their work forces. This approach could also be applied to nonregulatory

testing programs. For example, NIOSH could conduct occupational safety and health performance

tests of products used by small businesses and

publish the results in a fashion easily accessible

to small businesses, which could then use the results of these tests in purchasing decisions.

for the regulatory system, which penalizes firms

for violations of regulations, an injury tax system would levy a direct financial penalty on the

firm for each injury. Such an approach appeals

to many economists, but it presents a number of

difficulties.

Congress could also modify the structure of

business taxes to encourage investment in health

and safety control technologies, or it could provide direct assistance to businesses in financing

health and safety investments. Either decision

would provide some level of “social funding” for
Ch. 16—Economic Incentives, Reindustrialization, and Federal Assistance for Occupational Safety and Health ● 341

investments in occupational safety and health,

thus reducing their costs and encouraging firms

to undertake them. Four kinds of tax and assistance programs could be considered: investment

tax credits, accelerated depreciation, Government

loan programs, and direct subsidies. All have been

used to stimulate adoption of pollution controls,

and loan programs have been used, to a limited

extent, for occupational safety and health.

Tax incentives and financial assistance programs might spur the implementation of controls,

assist businesses in compliance, and possibly reduce the controversy of regulatory proceedings

because of the availability of sources of finance.

However, they would cause either a reduction in

Federal tax revenues or an increase in budget

outlays and could increase the complexity of U.S.

tax law or increase administrative burdens. Moreover, these programs can be inefficient, and would

affect other aspects of business investment

behavior, as well as the distribution of wealth,

income, and the burden of income taxes.

Federal policies concerning reindustrialization

might have either a beneficial or an adverse impact on workplace health and safety. It is possible that many of the improvements in worker

health and safety during this century occurred coincidentally with the introduction of new technologies, new processes, and new industries and not

as the result of conscious decisions to add controls to existing processes. A time of reindustrialization offers opportunities to integrate productivity-improving investments in plant and equipment

with the installation of control technologies, as

well as to exploit the fact that it is cheaper and

more effective to control a hazard when designing new plant and equipment than it is to retrofit

existing operations. Reindustrialization also affords an occasion to achieve greater levels of protection. However, there is also the danger that

combining policies that are designed to improve

productivity with those that address employee

health and safety will lead to an emphasis on productivity at the expense of health and safety.

Health and safety regulation may have negative effects on productivity, by requiring spending for controls that are “nonproductive,” compared with traditional measures of productivity.

But in the aggregate, this diversion is relatively

small, and may, in many cases, be offset by regulation-induced changes that improve plant productivity as well as employee health and safety

protection. Facing the need to redesign products

and process to comply with health, safety, and

environmental regulations, companies may fundamentally redesign product or process through

the use of new technology. For both the OSHA

vinyl chloride and cotton dust standards, employer compliance was associated with improvements in productivity. For the lead industry, it

is possible that new technology could be introduced that would simultaneously reduce worker

exposures, reduce the costs of controlling exposures, and improve productivity.

Financing for research and training activities

and for assisting small businesses could be provided by an Occupational Safety and Health

Fund. The Work Environment Fund of Sweden

offers a possible model for a U.S. fund that could

provide a new focus for enhanced efforts in control technology research, education and training,

and information dissemination.

Small businesses face special problems in making improvements for employee health and safety.

They often lack technical expertise in industrial

hygiene, safety engineering, and occupational

medicine, and they face financial difficulties as

well. Assistance to such firms could include Government loan programs, consultation, and Government testing and regulations of products purchased by small businesses. In addition, OSHA

and NIOSH could encourage the development of

programs to provide industrial hygiene, safety

engineering, medical surveillance, and worker

health and safety training to small businesses,

especially in regions currently lacking such

services.
—

Preventing

Injury and Illness

.,

7 .

Work-Related

in the Future

.
Contents

Future Trends . . . . . . . . . . . . .

Opportunities for Prevention

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Page

345

346

347

350

351

353

354

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Energy-Related Technologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Modernizing Old Industries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

New Technology=. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Rapidly Growing Occupations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..,+... ...,O

. . . . . . . . . . . . . . . . . . Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

LIST OF TABLES

Hazards in Coal Liquefaction

Ratios Among Coal Miners .

Table

17-1.

17-2.

No.

Potential Occupational

Standardized Mortality

Page

348

349

Plants

. . . . . .

. . . . . . . . . . . .

. . . . . . . . . . . .

LIST OF

Figure

17-1.

17-2.

17-3.

No. Page

352

353

353

Features of Standard Fermentor . . . .

Features of Contained Fermenter . . . . . . . . . . .

. . . . . . ., . . . . . . . .. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . ....** Frequency of Health

Investigations. . . . . .

Complaints in 55 Office

. . . . . . . . . . . . . . . . . . . . . .

Environment

. . . . . . . . . . . . . ,. . . . . . ..,*O.

.
17 ■

Preventing Work-Related Injury and

Illness in the Future

Looking ahead in occupational safety and

health, except in the most general way, is as difficult and open to error as predicting the future

in any field. In general, changes in plant and manufacturing techniques, shifts in types of jobs, and

attention to controlling hazards are expected to

reduce work-related injury and illness. Some new

and exotic hazards are certain to accompany new

processes, but what has been learned from controlling or failing to control current workplace

hazards can be applied to recognizing and controlling the new ones.

To some extent, the workplace of tomorrow

will be the workplace of today. Some worksites

and industries will change little, and even in those

that change, seemingly mundane factors will continue to contribute to workplace injury and illness. Inadequate guarding of machinery, poorly

designed hand and power tools, and inappropriate

walking and working surfaces will not go away

without attention to injury prevention. Some

long-known health hazards remain problems. For

instance, silica dust in plants, mines, and foundries continues to cause ill health. The absence of

controls in such situations underlines the importance for policymakers to understand how incentives for adopting controls work and do not work.

FUTURE TRENDS

There are a few sources of information about

expected trends in employment and other sources

for predicting where new technologies are likely to

be used; careful consideration of trends by leaders

in health and safety could lead to the development of controls to accompany the new technologies.

The 1984 edition of U.S. Industrial Outlook:

Prospects For Over 300 Industries (554), prepared

by the Bureau of Industrial Economics, DepartThe look at the future in this chapter is very

much constrained by knowledge of the present.

The changes that are described are evolutionary,

not revolutionary. That is not intended to imply

that revolutionary changes will not take place, but

it acknowledges that revolutionary changes are

far harder to predict. For example, the drafters

of the National Cancer Plan in 1970 failed to mention one of the most important biological advances, recombinant DNA (544), for the simple

reason that it had yet to be “invented. ”

The future will present a mix of the problems

of today and tomorrow. The mix, it can be said

with some confidence, is bound to change, and

certain new, just emerging problems, are expected

to capture the attention and efforts of safety and

health professionals in the years ahead. This expectation is in keeping with the observation made

earlier in this report that concern about the new

sometimes seizes the imagination and attention

of expert and lay person alike. This is particularity

likely to happen when the old problems are concentrated in industries or trades that are seen to

be on the way out and there is little incentive to

invest in them. It is a sure bet, however, that old

problems in old industries will not take care of

themselves if attention is diverted from them.

ment of Commerce, estimates that the U.S. population will grow throughout the 1980s at a rate

similar to that of the 1970s-0.9 percent per year.

The rate remains the same because the effects of

changes in fertility, immigration, the age of the

population, and mortality roughly cancel out. The

predictions for increases in fertility rates and legal

and illegal immigration and decreases in mortality would, by themselves, lead to an expected increase in the population growth rate. Balancing

those is the fact that women born during the baby

345
346 . Preventing Illness and Injury in the Workplace

boom of the 1940s and 50S are passing out of their

most fertile years, reducing the number of women

having children. Reduced mortality and aging of

the baby boomers will produce an increase in the

average age of the population.

The labor force increased by 23 million (26 percent) between 1972 and 1982. Part of the growth

resulted from the unprecedented increase in the

number of women entering the work force, the

remainder from the entry of young men. This

spectacular rate of growth will not continue during the next decade, when 17 million people (a

16 percent increase) are expected to enter the work

force. These projections indicate that prevention

of injury and illness in the next 5 years will be

affected by an aging work force including an increasing number of women.

Even this very general information can be of

value to health and safety professionals as they

look ahead to the next decade. For instance, older

workers may respond differently to prevention

training than younger workers. Women will require different considerations in the ergonomic design of jobs and personal protection equipment.

Information about which industries are likely

to grow and which are likely to decline is useful

for directing research in control technology and

for encouraging companies to consider injury and

illness prevention before a new plant is built and

new technologies installed. Anticipation of problems in the planning stages can help prevent serious problems later on. Gaining industries cited

in the 1984 report include the motor vehicle and

electronic-product-related groups. However, the

most rapid growth was expected in the service inOPPORTUNITIES FOR PREVENTION

Many new technologies should be inherently

safer for workers than those of the past, but new

processes will require modification of old or fabrication of new controls. Eight kinds of workplaces are discussed here as examples of changes

that are expected:

● Energy-related industries:

Synthetic fuel production

Coal mining

Off-shore oil drilling

dustries. The injury rate in those industries—

computer, banking, legal, and medical services

and related activities—is lower than the all-industry average. Nevertheless, the number of people

employed in them means that attention to safety

and health in those industries will be increasingly

important in the future.

The Environmental Protection Agency (EPA),

in cooperation with the National Institute for Occupational Safety and Health (NIOSH), has considered the production of a document that would

concentrate on environment and occupational

health and safety. As planned, the outlook would

have two parts. In the first, data available from

Federal sources about current and expected employment levels, injury and illness rates, compliance with Occupational Safety and Health

Administration (OSHA) regulations and EPA air

and water quality regulations, solid waste disposal, and energy and water use would be presented for each four-digit Standard Industrial

Classification code. Insofar as possible, information about occupational and environmental measures would be presented for each industry covered in the Department of Commerce Industrial

Outlook. A very useful feature of the EPA/

NIOSH document is that all the data are entered

in a computer network so that users with personal

computers can carry out their own analyses. The

second part of the document is a narrative, profiling each of the industry groups in terms of environmental safety and health, highlighting trends

in the work force, the use of new technology, the

handling of hazardous substances, and other related matters (220).

• Modernizing old industries

Steelmaking

Automobile manufacturing

• New industries

Semiconductor manufacturing

Biotechnology industries

● Rapidly growing occupations

Office work

In terms of expected numbers of workers, the

industries vary. Synthetic fuels may or may not
Ch. 17—Preventing Work-Related Injury and Illness in the Future . 347

become important in the future and even if they

do, large-scale production will take time to

achieve. Should that happen, a new work force

will have to be trained, and employment in the

industry could take off. Coal mining and offshore

oil drilling are employing more workers now.

With the introduction of larger, more efficient machinery in mining, the number of miners is expected to plateau and then decline. Oil drilling

employment will increase or at least remain constant so long as the search for oil fields is profitable. Steel and auto manufacture, despite some

recent resurgence, are not expected to employ as

many as they did in the 1970s.

Jobs in the semiconductor-related technologies

are expected to increase. Biotechnology is, perhaps, at a point in its development analogous to

that of the semiconductor business a decade or

two ago. If some of the newly created biotechnology firms are successful, there should be more

jobs in this field, but the maximum number of

workers is likely to be small and they will be

highly trained.

Technologies affecting office work crosscut all

sectors, both public and private, and are rapidly

growing as the U.S. economy becomes increasingly information-oriented. It is expected that the

number of workers in offices or at least doing

work that is now associated with offices will increase over the next few decades.

Consideration of future employment opportunities is directly related to health and safety. Not

only do different jobs carry different risks, but

more important, work is essential to good health.

A number of studies have shown that medical

services are more heavily used during periods of

unemployment, that mental health problems increase in number and severity, and that suicides

increase. Working is good for health, and proper

attention to identifying and controlling hazards

in the workplace can prevent injuries and illnesses.

Energy-Related Technologies

The fuel crises of 1973 and 1978 led to dramatic

changes in the production and use of energy in

the United States. The Department of Energy was

formed, and resources were marshaled for the Nation to become energy independent through finding new energy sources and new technologies for

conserving energy. Production of liquid fuels from

coal, oil shale, and tar sands will involve new

technologies and new hazards, and new controls

will be needed. Increased coal use will stimulate

the purchase and use of new mining machinery

that will require appropriate controls.

Synfuel Production

Synthetic fuel (synfuel) production methods

break down complex molecules of relatively abundant and naturally occurring carbonaceous material such as coal or oil shale to produce simpler,

cleaner, more efficient fuel. Although these technologies have been used before on a small scale,

they have never been economically competitive

with fuel production from crude oil and have remained commercially undeveloped. These technologies, though, could eventually be adopted by

the United States to achieve energy independence.

Congress established the U.S. Synthetic Fuels

Corporation (SFC) to fund projects that would

lead to production of clean and safe energy. The

SFC has proposed guidelines to monitor emissions

in the workplace and to the surrounding environment (653):

Any contract for financial assistance shall require the development of a plan, acceptable to the

Board of Directors, for the monitoring of environmental and health-related emissions from the

construction and operation of the synthetic fuel

project (486).

Plans requesting financial assistance are to include details of a monitoring system, listing substances to be monitored; the frequency, location,

methods, and durations of monitoring; and worker exposure and health surveillance programs. A

worker registry is required to integrate worker exposure data, medical records, demographic information, and job classification codes so that any

trends in work-related injury and illness can be

identified.

Production of liquid fuel from shale oil involves

liberation of some chemicals that are carcinogenic,

and studies of pilot plant workers in this country

report dermatitis, eye irritation, and thermal

burns from job exposures. Fire and explosion are

hazards because of the operating temperatures and

pressures necessary for synfuel production.
348 . Preventing Illness and Injury in the Workplace

Table 17-1 lists the potential hazards that could

be expected in a coal liquefaction plant. Problems

are encountered during coal handling and preparation, during the process itself, and during waste

treatment. Estimates have been made of the chemical products and byproducts that might be found

at each point in the process so that worker protection can be considered during design (575).

Concern about these hazards has contributed

to systematic analysis of plans of future synfuel

plants in an effort to anticipate causes of injury

or illness. For instance, NIOSH reports one example of the success of this approach. High pressure vessels for coal liquefaction operate at extremely

high pressures and temperatures and contain flammable material. Engineers, recognizing the potential hazard from a high-pressure vessel used in a

bench-scale (laboratory-sized) coal liquefaction

process, placed protective barriers around it.

When the vessel unexpectedly exploded, harm was

prevented. In another instance, reinforced concrete walls between the liquefaction system and

the operating control room protected operators

from injury and operating controls from damage.

The unharmed operators were able to shut down

the process, thus preventing further explosions

and fire. These same techniques could be applied

in future operations to prevent harm at all levels

of operation (575).

Coal Mining

Most coal is used in the traditional way to generate power directly in steam plants, and its use

has increased during the past decade of uncertainty about oil supplies. Use is expected to increase further, to double, in fact, by the year 2000,

to as much as two billion tons per year (536).

Mining and moving coal are hazardous. Over

100,000 coal miners have been killed since 1900),

and coal workers’ pneumoconiosis (black lung disease) has taken a high toll. A mortality study of

23,233 miners selected randomly from those eligible for United Mineworkers of America health and

retirement funds as of January 1, 1959 and followed through December 31, 1971 with 99 percent followup, reported excess mortality for stomach cancer, influenza, asthma, tuberculosis, and

accidents (392) (see table 17-2). Unless steps are

taken to assure prevention of work-related injury

and illness in coal mines, an increase in production may lead to excess morbidity and mortality.

Changes in technology are introducing new

hazards into the mine. For instance, the diesel enTable 17-1 .—Potential Occupational Hazards in Coal Liquefaction Plants

System, unit operation

or unit process Potential hazards

Coal handling and

preparation system. . . . . . . . Coal dust, noise, fire, explosion, asphyxia (nitrogen and

carbon monoxide gases), burns

Liquefaction system . . . . . . . . . Phenols, ammonia, tars, thiocyanates, PAH’s, carbon

monoxide, hydrogen sulfide, hydrocarbons, fires,

explosions, burns, high pressures, noise, ash, slag,

mineral residue, spent catalyst

Separation system . . . . . . . . . . Oils, phenols, hydrogen cyanide, ammonia, hydrogen

sulfide, burns, fires

Upgrading and gas

purification . . . . . . . . . . . . . . . Light hydrocarbons, phenols, ammonia, hydrogen sulfide,

carbon dioxide, carbon monoxide, burns, fire,

explosion, high pressures

Shift conversion . . . . . . . . . . . Tar, naphtha, hydrogen cyanide, fire, catalyst dust, burns,

hot gases (carbon monoxide, hydrogen)

Methanation a 

. . . . . . . . . . . . . . . Carbon monoxide, methane, nickel carbonyl, spent

catalyst dust, fire, burns

Waste treatment facilities . . . . Hydrogen cyanide, phenols, ammonia, particulate,

hydrocarbon vapors, sludges, spent catalyst, sulfur,

thiocyanates

alndirect liquefaction

SOURCE: (575),
Ch. 17—Preventing Work-Related Injury and Illness in the Future . 349

Table 17.2.-Standardized Mortality Ratios Among Coal Minersa

Deaths

Cause of death Observed Expected SMRb

All causes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,628 7,506.1 101.6

All malignant neoplasms . . . . . . . . . . . . . . . . . . 1,223 1,252.2 97.7

Respiratory organs . . . . . . . . . . . . . . . . . . . . . 373 331.0 112.5

Stomach cancer . . . . . . . . . . . . . . . . . . . . . . . . 127 91.9 134.9b

Major cardiovascular diseases . . . . . . . . . . . . . 4,285 4,501.2 95.2b

Chronic and unqualified bronchitis . . . . . . . . . 26 29.0 89.7

Influenza . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 14.8 189.6b

Emphysema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170 118,3 143.7b

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 18.3 174.9b

Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 43.3 145.5b

Coal worker’s pneumoconiosis. . . . . . . . . . . . . 187 — —

Accidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 408 283.0 144.2b

%al miners covered by the United Minewotiers of America health and retirement funds The vital statusof 22,998 miners

was verified.

bstandartjizedmortafity ratlo(sMR) is significantly different from 100at the5 percent confidence level

SOURCE (392)

gine is increasingly replacing electrically powered

mine equipment. The exhaust emissions from such

engines include cancer-causing polynuclear aromatic hydrocarbons, respiratory system irritants,

and asphyxiating carbon monoxide and carbon

dioxide.

Control technologies for diesel engines are well

known. Diesels operating under ideal conditions,

with proper maintenance and operation, produce

minimal amounts of contaminants. In underground coal mines, ventilation can be increased

to keep contamination at a minimum. Filters, recirculation of exhaust gases through the engine,

catalytic converters, and exhaust scrubbers can

also be used to clean the exhausts (477). Such controls are difficult and require high degrees of maintenance to assure that they are functioning properly.

Other examples of a production technology that

may increase risk of injury in the mines include

continuous miners and long-wall mining. Continuous miners are machines that cut into a coal vein

and transfer loose coal back to a conveying mechanism for transport to the surface. While they increased productivity when they were phased into

the mines from 1950 to 1970, the fatality rate rose

slightly and the disabling injury rate continued

at a relatively constant level. Long-wall mining

is a mining method in which a machine extracts

coal by moving back and forth across a face while

conveying the coal to one of two tunnels dug parallel to each other and at right angles with the coal

face. The coal is transported to stations for transfer to the surface via conveyors running through

the tunnel. Supports at the face protect miners

while allowing the roof to cave in behind the face

just worked, preventing unwanted roof fall. Longwall mining may reduce fatalities but not necessarily injuries or harmful dust levels (536).

Outer Continental Shelf Oil Production

Another energy area expected to grow is oil and

gas production on the outer continental shelf. Demand for energy has led to the development of

technologies for deep water oil and gas exploration in remote locations and under extreme environmental conditions. An increasing number of

workers, already at high risk because of the nature

of oil extraction, will face even greater risks of

work-related injury and illness. In the period 1970-

79 employment in outer continental shelf oil and

gas exploration grew by 71 percent (to a work

force of 61,500) for an average annual growth of

3 percent. Moreover, there was a 20 percent per

year increase in two years, 1978 and 1979 (319).

There are two areas of concern. The first is the

design and stability of drilling rigs. A combination of bad weather and inadequate structural

strength has resulted in major catastrophes, such

as the failure of a mobile offshore drilling unit in

1982 in the North Atlantic that killed 84 workers.

The second area is the risk to workers from the

work itself. Drilling is frequently continuous, being done in shifts 7 days a week, under difficult
350 Preventing Illness and Injury in the Workplace

conditions. Drill space is cramped and pipes, tubing, tongs, and other material are heavy and cumbersome. Walking and working surfaces are slip

pery from drill fluids. The work is outside, so

weather is often a factor. The severity of these

conditions is heightened on offshore drill rigs and

may be expected to be even more severe on offshore units located in remote areas, where weather

may be extreme.

Modernizing Old industries

U.S. manufacturers are facing intense competition from Japanese and Western European companies, and that sector of the U.S. economy may

be declining. The declines have been attributed

to inadequate investment in new plant, changing

market conditions, rising labor costs, and costgenerating Government regulations. Whatever the

exact reasons—and they are a matter of argument—it is agreed that the U.S. steel industry is

no longer the first in the world. Changes in the

qualities of cars that induce people to buy an auto

resulted in U.S. consumers buying more foreignbuilt models, and U.S. domination of auto sales

is a thing of the past. Both these industries are

retooling and retrenching to meet the foreign

threats, and there will be opportunities to build

in features to prevent work-related injury and

illness.

Steelmaking

Steelmaking is one older U.S. industry that

must change if it is to survive. Increased research,

development investment, and the use of new technology are all required to compete with steelmaker from other countries (538). Unfortunately,

this has become a chronic public policy problem.

As mentioned in chapter 16, the Steel Tripartite

Advisory Committee, made up of steelworkers,

steelmaker, and Government officials, was established by President Carter in the 1970s to attempt

to revitalize this industry.

The Committee’s Working Group on Technological Research and Development concluded that

(458):

environmental and occupational safety and

health issues should be considered as an integral

part of technological research and development

in the steel industry. Research in steel technology

should continue to take into consideration features for protecting workers and improving the

ambient environment both with respect to new

and to existing steel facilities.

The Working Group went on to recommend

Federal funding for research and development and

for demonstration plants. These recommendations

were agreed to in recognition of the high risk of

work-related injury and illness in steelmaking, and

the opportunity to reduce costs through development, demonstration, and adoption of control

technologies.

New technologies for steelmaking are more productive and likely to cause fewer work-related injuries and illnesses. For example, continuous casting is used to produce 80 percent of Japanese steel

and 32 percent of U.S. steel. It requires less

energy, costs less per ton of steel produced, and

produces higher quality steel and less pollution.

It also eliminates soaking pits and reheating furnaces and requires less coke making, three steps

in the traditional process that produce emissions

that are associated with disease. In general, better working conditions exist in continuous casting

steelmaking plants.

Another new steel technology is direct reduction of iron ore rather than the current process

of blast furnace and coke oven. Since direct reduction can be done without coke, risk of lung

cancer from coke oven emissions can be eliminated. Other technologies that show promise for

the 1990s and that can be made less likely to cause

work-related injury and illness include formcoking (another process reducing coke oven emissions), direct casting of sheet and strip metal from

molten steel, and one-step steelmaking directly

from ore. In the latter two processes, potentially

hazardous steps in the process are eliminated, thus

reducing risk of worker harm.

The same changes that improve production and

reduce risks will cause further shrinking of the

work force. In the late 1970s, 450,000 workers

were employed in steel; in 1983, the number was

less than 250,000, and it continues to decline.

Automating

Automating includes many kinds of industrial

operations, ranging from metalworking in steel-
Ch. 17—Preventing Work-Related Injury and Illness in the Future ● 351

works and foundries, to forging and machining

of metal parts, to fabrication of plastic parts, and,

finally, to assembly. Hazards in the steelworks

and foundries include noise, heat, dust, and gas.

Forging and machining are also hazardous. Auto

body painting presents special hazards due to the

large volumes of paint and solvents used during

assembly. Stress-related illness may result from

monotonous work and shift work.

Conventional controls are available for these

hazards. Local exhaust and dilution ventilation

are widely used in all phases of manufacture and

can be expected to be improved in new processes.

Automated spray painting in booths reduces or

eliminates worker exposure. The use of robots in

areas of high hazards can reduce risks to workers.

Robots or automated manufacture also introduces hazards. There have been cases here and

abroad of workers being injured or killed by automated machines. This points to the need for machines to stop when workers inadvertently come

in contact with them or to be installed where they

keep workers out of danger zones while the machine is connected.

New Technologies

New technologies that are burgeoning or promise to burgeon into full-scale industries present opportunities to prevent work-related injury and illness in the early stages at low cost. The most

Photo credit: NIOSH

This paint spraying line has been automated using

robots. Future developments in robotics may reduce

worker exposures in other hazardous operations

successful of the new industries is the semiconductor industry, and the most glamorous of the

promising ones is biotechnology.

Semiconductor Manufacture and Related Industry

The continuing demand for computer and video

devices for industry and commerce, coupled with

consumer electronics and computer technologies

for microelectronic applications, is expected to

fuel the growth of this industry.

Microelectronics has been estimated to have a

world market of more than $19 billion and employ a work force of 500,000 worldwide (258).

The risk of work-related injury appears to be

lower and illness appears to be higher in this industry. In 1981 the Bureau of Labor Statistics reported the injury incidence rate for semiconductor and related devices as 4.6 cases per 100

full-time workers and lost-workday cases as 2.0

per 100 workers, compared with an all-industry

average incidence rate of 8.3 cases per 100 workers and lost-workday cases of 3.8 per 100 full-time

workers (608). The California Department of Industrial Relations conducted a survey in 1980 that

showed workers manufacturing semiconductors

had 1.3 illnesses per 100 workers compared with

a rate of 0.4 per 100 workers in the general manufacturing industries. Lost time resulting from

work-related illness was three times more common among semiconductor workers (18.6 percent

of all lost-workday cases) than in general manufacturing industries (6.0 percent of all cases) from

1980 to 1982. Almost half (46.9 percent) of all

work-related illness among Californian semiconductor workers in this period was reported to result from exposure to toxic substances (258).

Known health hazards include metal fumes

from soldering, toxic chemicals such as epoxy

resins and chloronaphthalene, silica flour used in

making insulating materials and dielectrics,

solvents for decreasing solder joints, and acids for

etching printed circuits. The volumes of these

chemicals used in California in 1979 were large:

Over two million gallons of solvents; more than

two million gallons of sulfuric, hydrofluoric, and

other acids; more than one-half million gallons

of sodium hydroxide and other caustics; and over

one and one-half million cubic feet of arsine, phos-
352 ● Preventing Illness and Injury in the Workplace

phine, diborane, and other toxic cylinder gases

were used in processing semiconductors (258).

Existing technologies, if applied, should be sufficient to control these hazards. Local exhaust ventilation is appropriate for soldering and etching

operations. Substitution may be appropriate

where solvents are found to be more toxic than

expected. Replacement of carbon tetrachloride

and trichloroethethylene (after they were shown

to be carcinogenic among laboratory animals)

with perchloroethylene is an example of this.

Biotechnology

Recombinant DNA technologies, operating at

moderate pressure and temperature, have fewer

inherent physical hazards than traditional chemical processes, which sometimes operate at

dangerously high pressures and temperatures. Furthermore, to the extent that biotechnology uses

pinpoint production techniques to produce particular chemicals, it will eliminate the currently

encountered mixtures of chemicals, contaminated

with unwanted toxic compounds, that are common in conventional chemical synthesis.

Biotechnology’s hazards center on the possibility that the microbes used in it or products produced from them will be harmful to human health

or the environment. Since some of these organisms are “new,” in that they have been produced

by genetic engineering, there is concern among

some people that they present significant risks

(541,548). Most experts in the field see the organisms being used for or proposed for use as production organisms as “crippled” and unable to survive outside the laboratory or workplace.

More of a problem are “new” micro-organisms

developed to be released into the environment.

Because they will have to compete with organisms

that occur naturally, they cannot be crippled. For

that reason, EPA is now considering regulating

the intentional release of such organisms, and

Congress has expressed interest in a regulatory

scheme.

In the area of using micro-organisms for production, the United States appears to have studied questions of worker health more carefully than

other countries. The U.S. voluntary approach to

worker protection is monitored by the Research

Advisory Committee of the National Institutes of

Health, and NIOSH has developed guidelines for

medical surveillance of fermentation and biotechnology plant workers (259a).

NIOSH industrial hygiene surveys of six industrial laboratories using recombinant DNA technologies found wide variation in safety and health

practice among them. Practices ranged from “exemplary” plants with health and safety programs

for workers to plants where workers were allowed

to smoke and drink in the laboratory and to store

beverages in laboratory refrigerators, and where

procedures for biological waste-disposal were

undocumented—all unacceptable practices.

Figures 17-I and 17-2 contrast a standard fermenter with a contained one, which would contain organisms and culture media used in biotechnology. The contained fermenter provides for

double filtering of exhaust gases to control emissions, a special mechanical seal at the top to provide extra protection against loss of growth medium that contains bacteria, and an alarm to warn

operators of ruptured seals, thus helping prevent

possible loss of contaminated broth. These features of the contained fermenter provide increased

protection both to workers and the environment.

Figure 17-1 .—Features of Standard Fermenter

Exhaust

to atmosphere 

unfiltered

Compressed air Dip tube

inlet harvest and fill

line

Cooling jacket

Agitator

Air sparger

SOURCE: NIOSH
Ch. 17—Preventing Work-Related Injury and Illness in the Future . 353

Figure 17-2.—Features of Contained Fermenter

Second

back up Exhaust gas

sterile filter filter system (1)

Special double mechanical

Primary seal with sterile fluid purge

sterile (2) and loss of pressure air

filter Dip tube

Compressed air harvest and fill

inlet line (3)

Other features

(6) Collection of

contaminated

condensate and

sterilization before

release

(7) System validation

before operation

(8) Monitoring program

(9) Operation with

detailed protocol

et

Agitator

Air sparger

SOURCE: NIOSH

Rapidly Growing Occupations

Office Work

Thirty-three million people work in office jobs

in this country. The advent of new technology

such as computers using video displays and advanced copying machines have changed the office. To some extent, machines can pace the work,

introducing a new source of stress. Lighting and

furniture, ignored in the installation of the first

computers and word processors, are important

to worker comfort and probably to health and

safety.

The energy crisis has resulted in office buildings

being tightly insulated. Unfortunately, improved

insulation that keeps heat or cooled air in also prevents air exchange from cracks and other tiny

leaks and increases indoor air pollution. Because

building air is recirculated to conserve energy

rather than directly exhausted to the outside,

many ventilation standards are now inadequate.

Formerly unacceptable, the practice of recirculation has been adopted to reduce the relatively high

costs of heating and cooling. Harmful air contaminants, aerosol can chemicals, tobacco smoke, and

pathological micro-organisms may reach unacceptable levels. Some building technologies also

contribute to the contamination. For example, the

irritating and potentially carcinogenic compound

formaldehyde is emitted from plywood, and naturally occurring radioactive radon gas may be

emitted from certain building sites. Even when the

exact causes of workers’ health problems remain

unidentified, the problems have been reversed

with increased ventilation.

Health effects have been related to indoor air

pollution. At high concentrations, indoor air contaminants may cause irritation of sensitive tissues,

and acute or chronic illness. Many substances appear to act primarily as irritants at low exposure

levels, inducing local inflammatory reaction in the

eyes, nose, lung, or other sites (25). NIOSH made

159 health hazard evaluations in response to requests between 1971 and 1983. Table 17-3 shows

that irritation of eyes and throat were reported

in 81 and 71 percent of the cases respectively (661).

Control of indoor air pollution maybe achieved

by increasing ventilation rates, eliminating the

source of contamination, and air cleaning (25).

Air cleaning is generally limited; although it filters

particles, it does not remove gases and vapors.

Table 17-3.-Frequency of Health Complaints in

55 Office Environment investigations

Percent of buildings

Symptom with complaint

Eye irritation . . . . . . . . . . . . . . . 81

Dry irritated throat . . . . . . . . . . 71

Headache . . . . . . . . . . . . . . . . . . 67

Fatigue . . . . . . . . . . . . . . . . . . . . 53

Sinus congestion . . . . . . . . . . . 51

Skin irritation. . . . . . . . . . . . . . . 38

“Shortness of breath” . . . . . . . 33

Odor . . . . . . . . . . . . . . . . . . . . . . 31

Cough . . . . . . . . . . . . . . . . . . . . . 24

Dizziness . . . . . . . . . . . . . . . . . . 22

Nausea . . . . . . . . . . . . . . . . . . . . 15

SOURCE: (661).
354 ● Preventing Illness and Injury In the Workplace

Ventilation standards, if they are to guard against

indoor air pollution under the new conditions,

need to be rewritten.

There are reports that office work, especially

work involving routine use of computers for document completion and filing, is being moved from

the office to the home. While working at home

is attractive to many people, it will also introduce

SUMMARY

The ability to anticipate change is fundamental to preventing work-related injury and illness.

Knowledge about the sectors of the economy

where changes are likely to take place, what the

changes might be, and how they might affect

workers will help responsible officals carry out

their mandate under the Occupational Safety and

Health Act and to improve occupational health

and safety in other ways.

Changes can be expected in energy-related industries, modernization of older industries, industries relatively new to the economy, and in the

rapidly growing area of office work. New technologies are being introduced, some of which

could cause work-related injury and illness. But

these changes also present opportunities for preventing work-related illnesses and injuries.

The production of synthetic fuels also creates

possible worker exposures to a number of different hazardous substances, as well as a potential

for fires and explosions. Coal mining has always

been hazardous, not only in terms of injuries, but

is also associated with increased worker illness.

The use of diesel engines and new production technologies introduce new hazards underground.

Operations on offshore oil and gas rigs result in

relatively high injury rates.

Modernizing older industries such as steelmaking and automating should provide opportunity

for additional protection of workers. Meanwhile,

brand new technologies, such as electronics and

biotechnology, are being introduced. Greater attention should be paid to worker health problems

in the manufacture of semiconductors because of

the use of toxic chemicals. Biotechnology has the

new concerns. Stress may be increased by a sense

of isolation from the workplace and coworkers,

and opportunities for advancement, which are a

positive force in most workers’ lives, may not exist. Also, to the extent that office machines bear

hazards, those are likely to go unrecognized in

the dispersed workplace and even more likely to

go uncontrolled (25).

potential of reducing exposures to inherently

dangerous chemical processes and potentially hazardous chemical mixtures. But care must also be

taken in handling the micro-organisms used in

these processes.

Office work is one of the most rapidly changing occupations as new technologies are proliferating. Since one-third of the work force are in offices, even low rates of work-related injury and

illness can be of concern. Three areas where attention is needed in offices are indoor air pollution,

stress, and the ergonomic problems associated

with VDTs.

But the problems of the past will also remain.

It will be difficult to convince smaller firms to invest in control technologies, especially as they will

find the financing difficult. Companies relying on

older technologies, such as those found in the

basic industries, remain reluctant to install controls, especially when times are hard. The tortuous

process of court battles over standards is likely

to continue, leaving the public and workers somewhat bewildered about the protection the Federal

Government attempts to afford them.

The incentives for control that are discussed in

this assessment deserve careful attention to discern

how they work or do not work to encourage better health and safety programs. It is by now clear

that regulations are slow to emerge from OSHA,

that enforcement will always be limited by the

small corps of inspectors, and that OSHA consultation services cannot reach every workplace that

could benefit from them. Continuing demands

from a work force and a public less willing to accept risk of injury and illness will impose greater
— . . .

Ch. 17–Preventing Work-Related Injury and Illness in the Future ● 355

pressures on workers’ compensation, liability law interest in the role of the general environment and

and the courts more generally, and insurance com- the workplace in health has probably become part

panics and voluntary associations interested in of the overall social consciousness of the Nation.

health and safety. One of the measures of the importance of those

The great interest in environmental health that ideas will be improvements in occupational health

developed in the 1970s remains alive and well, and and safety in the years to come.
Appendixes
.

Appendix . A. —Supplemental Information

on OSHA and NIOSH

Other Reports on OSHA and NIOSH

The General Accounting Office (GAO) has examined a number of aspects of OSHA and NIOSH operations. It has reported on standards-setting activities

of OSHA and the criteria-setting activities of NIOSH

in two different reports (494,501) and generally criticized the slow pace of the development of new standards, and the lack of coordination between the two

agencies. GAO has examined emergency temporary

standards (495,496) and the procedures used by OSHA

to grant employers variances from standards (497),

and expressed concern that OSHA’s activities were not

sufficient to ensure worker health and safety. GAO

has also criticized OSHA’s management of its consultation program (505), OSHA’s monitoring of State Programs (500), as well as the administration of NIOSH’s

HHE program (503).

GAO has reviewed OSHA’s health inspections

(502), its safety inspections (504), and the procedures

used for scheduling complaint inspections (507), and

was critical of several aspects of OSHA’s inspection

activity. GAO has in two reports criticized OSHA’s

data collection efforts, pointing to inadequacies in data

on injuries and health hazards and OSHA’s failure to

use the information it collects through accident investigations (499,508). A 1984 GAO report examined

OSHA’s policies of encouraging the informal settlement of citations (511).

Mary Jane Belle, of the Congressional Research

Service, prepared a report in 1981 on OSHA reform

(530). She has also written and updated a Congressional Research Service Issue Brief on OSHA (533).

Crisis in the Workplace by Nicholas Ashford (30)

and Bitter Wages by Joseph Page and Mary-Win

O’Brien (361), provide accounts of some of OSHA’s

early history and present their evaluations of governmental activities. Other studies of occupational health

and safety regulation are Robert Smith’s The Occupational Safety and Health Act (44 and John Mendeloff’s

Regulating Safety (300). David P. McCaffrey, OSHA

and the Politics of Health Regulation (290) gives a history and analysis of the health standards issued during OSHA’s first decade, while Steven Kelman’s Regulating America, Regulating Sweden (245) provides a

comparison of OSHA and its Swedish counterpart. In

his collection entitled OSHA: History, Law, and Po/-

icy (307), Benjamin W. Mintz provides numerous excerpts from primary source documents related to many

of the important disputes about OSHA standards and

enforcement activity, employee rights, and the history

of State programs,

Three other reports on OSHA are of special interest. Two were prepared by Presidentially appointed

groups. The first, appointed by President Ford and

often referred to as the MacAvoy Commission, examined OSHA’s safety standards and recommended that

OSHA issue performance standards (276). The second,

an Interagency Task Force appointed by President

Carter, made a large number of recommendations on

OSHA inspection activity, creation of economic incentives for OSHA compliance, establishing cooperative programs, and reforming regulatory activity

(228). In addition, two academic economists, Richard

Zeckhauser and Albert Nichols, studied OSHA regulation at the request of the Senate Committee on Governmental Affairs, which published their report in 1978

(685),

OSHA Standards Issued After Rulemaking

As described in chapter 12, OSHA has the authority to issue new standards, and to modify or revoke

existing standards using procedures specified in the Occupational Safety and Health Act (OSH Act). Tables

A-1 and A-2 present details of the rule-making proceedings that have resulted in final standards during

OSHA’s first 13 years. These proceedings can begin

with the receipt of a Criteria Document from NIOSH,

the creation of an ad hoc advisory committee, or the

publication of an Advance Notice of Proposed

Rulemaking. Although, in theory, both of these latter two might occur in the same proceeding; in practice they have not. In fact, in recent years, OSHA has

tended to use the Advance Notices, and has not used

ad hoc advisory committees. (The exceptions are

standards involving the construction industry, for

which OSHA is required, by its own regulations, to

consult with the standing Construction Safety Advisory Committee. ) Moreover, in recent years, NIOSH

has issued few criteria documents. Proceedings are

now more likely to begin with a petition from an interested group, such as a union, for a standard,

The formal Notice of Proposed Rulemaking and

publication of the Final Standard and statement of reasons are necessary steps in order to issue a standard.

A public hearing is not essential, unless an interested

party requests it. For major and controversial standards, a hearing is invariably requested.
360 . Preventing Illness and Injury in the Workplace

Under section 6(f) of the OSH Act, “[a]ny person

who may be adversely affected by a standard issued”

by OSHA can challenge the standard in any of the U.S.

Courts of Appeal. A column in tables A-1 and A-2 indicate if any challenge occurred, the circuit in which

it was filed, and the date of the decision. Table A-3

lists the names and citations for these cases.

Finally, OSHA has for a number of its standards,

taken formal steps to reconsider and revise standards

that had been issued in final form. The last column

of tables A-1 and A-2 list these actions.

OSHA Enforcement Activity

Tables A-4 to A-n present detailed information

concerning inspection activity by OSHA since Fiscal

Year 1973 and the State programs since Fiscal Year

1976. The data for these tables were provided by

OSHA. Table A-4 provides the number of inspections,

both for safety hazards and for health hazards. Table

A-s presents these inspections according to OSHA’s

priority categories—fatality/catastrophe investigations, complaint inspections, programed inspections,

and follow-up inspections. Table A-6 gives the numbers of inspections by major industry groups.

Tables A-7 to A-11 include information on the various types of violations issued by OSHA. The OSH

Act specifies that penalties be imposed on employers

for violations of standards. Except in the case of de

minimus violations that have “no direct or immediate

relationship to safety or health, ” and other-thanserious violations, OSHA must issue a citation, propose a penalty, and set a “reasonable” abatement

period.

A “serious” violation is issued for hazards that present a “substantial probability of death or serious physical harm” to employees. A fine of up to $1,000 for

each serious citation can be imposed. An other-thanserious violation is not explicitly defined in the Act,

but it falls between serious and de minimus violations.

These violations have also been termed “non-serious

violations.” OSHA and OSHRC interpret other-thanserious violations to involve conditions that have a direct and immediate relationship to worker safety and

health, but without a substantial probability of death

or serious physical harm. Although a fine of up to

$1,000 could be imposed for these violations, in practice the proposed fines are substantially smaller.

‘Willful” violations are defined as those that are “intentional and knowing, as distinguished from accidental, and display a careless or reckless disregard or plain

indifference to the Act or its requirements. ” (333).

Employers will usually correct a hazard after being

found in violation. Employers who subsequently are

found to violate the same standard or a similar standard may be issued “repeated” violations. Fines of up

to $10,000 may be imposed for both willful and repeated violations. OSHA’s largest penalties usually involve an employer’s “failure to abate” or correct a hazard. The OSH Act authorizes penalties of up to $1,000

for each day that the hazard continues beyond the day

it was supposed to have been abated. In practice, these

have been limited to a maximum of 10 days or $10,000.

The Act also authorizes criminal prosecution in several situations: First, a willful violation that results in

an employee’s death may be punished by criminal penalties including a fine of up to $10,000, or 6 months

imprisonment, or both. For a second conviction, these

maximum penalties are doubled. There have been only

a handful of these cases under the Act. In addition the

Act provides for criminal penalties for OSHA officials

who give an employer unauthorized advance notice

of an inspection, and against anyone who falsifies

OSHA-required records, or uses force to interfere with

the work of an inspector, although there have not been

any cases brought for these last three types. (For a

more detailed discussion, see 307,333,408. )

In practice, penalties are substantially lower than

the maximum penalty amounts outlined above, reflecting, in part, OSHA’s discretion in setting penalties. In

proposing penalties, OSHA considers the gravity of

the violation, the good faith of the employer, the size

of the business, and the employer’s previous history

of compliance.

Activities of Other Federal Agencies

OSHA and the 25 State Programs are directly responsible for ensuring the health and safety of most

private sector workers in the U.S. However, workplace

health and safety for some private sector workers are

the responsibility of other Federal agencies. In general,

health and safety conditions for most public sector

workers are not directly regulated by OSHA, although

State Programs, at least in theory, cover State and

local employees in States with State Programs. Finally,

the regulations issued by several other Federal agencies also affect job safety and health, even though

workplace conditions are not the primary focus of

these agencies.

The constellation of governmental bodies with

workplace safety and health responsibilities is summarized in table A-12. The OSH Act directly regulates

“employers,” who are defined as persons and businesses who have employees and are engaged in interstate commerce (Section 3(s)). This generally covers

private sector employers, although anyone who is selfemployed and who has no employees is not directly

subject to OSHA regulation.
App. A—Supplemental Information on OSHA and NIOSH ● 361

In addition, the occupational health and safety of

some private sector employees is regulated by other

agencies. Section 4(b)(1) of the OSH Act provides that

the OSH Act does not apply to “working conditions”

for which other agencies “prescribe or enforce standards or regulations affecting occupational safety or

health. ” These exclusions are, in some instances, for

all aspects of occupational safety and health; in others

only for certain hazards. For instance, the Mine Safety

and Health Administration (MSHA) is responsible for

all safety and health hazards associated with mining.

The Nuclear Regulatory Commission, in contrast, is

responsible for assuring that the workers under their

jurisdiction are adequately protected from radiation

exposure only; OSHA is responsible for all other

workplace hazards.

The boundaries of authority are clear in some cases,

while in others disputes have arisen. The Federal Aviation Administration (FAA) has requirements concerning the health and safety of flight crews, but coverage

of aviation ground crews has been a focus of dispute

between the FAA and OSHA.

Certain jurisdictional uncertainties have been resolved by agreements between OSHA and other agencies. The Department of Energy, through a letter of

understanding, has responsibility to “prescribe and enforce occupational radiological and nonradiological

safety and health standards” for the workers it covers. That 1974 agreement reaffirmed a 1964 letter of

understanding between the then Atomic Energy Commission and the Department of Labor concerning

responsibilities under the Walsh-Healey Act.

Recently, Congress temporarily transferred jurisdiction over stone and gravel quarries from the Mine

Safety and Health Administration to OSHA for several months. Inspection authority for this industry has

now returned to MSHA. Current and future jurisdictional disputes may be resolved through letters of understanding and inter-agency agreements, or through

congressional and court actions.

The employees of the Federal Government, as well

as of State and local governments, are not directly regulated by OSHA. However, Section 19 of the OSH

Act requires that the head of each Federal agency provide an occupational safety and health program for

agency employees that is “consistent with” the standards issued by OSHA. Three different Presidents have

issued Executive Orders concerning the health and

safety of Federal workers (Executive Order (E. O.)

11612, July 26, 1971; E.O. 11807, Sept. 28, 1974; E.O.

12196, Feb. 26, 1980). There is a Federal Advisory

Council on Occupational Safety and Health, appointed

by the Secretary of Labor, that consists of 16 members--8 representing Federal agencies, and 8 representing Federal employee labor organizations. OSHA also

provides technical assistance to other Federal agencies

concerning the health and safety of Federal workers.

The health and safety of State and local government

employees is the responsibility of the States and

localities that employ them. Any State that establishes

a State Program must provide an occupational safety

and health program for state and local employees that

is “as effective as the standards” adopted for private

sector workers. But State and local government employees in States without State Programs are not covered by this requirement.

In addition, several other Federal agencies can take

actions that affect worker health and safety. The Environmental Protection Agency (EPA) regulates pesticides under the Federal Insecticide, Fungicide, and

Rodenticide Act and regulates toxic substances under

the Toxic Substances Control Act. In either case, EPA

actions to allow, limit, or prohibit the use of particular substances may affect employee health and safety.

In fact, in many cases, the exposed workers may be

the group most affected by these actions. This may

also happen with actions taken by the Consumer Product Safety Commission in regulating hazardous consumer products.

Comparison of Protective Levels

The NIOSH list in Summary of NIOSH Recommendations for Occupational Health Standards contains

recommendations for a total of 163 hazardous substances and work conditions. There are 74 substances

which have no complications, and these are included

on the comparison list. There are also 11 groups of

71 separate substances for which NIOSH has made recommendations. Only 43 of these, however, were conducive to comparison. In addition, there are six substances in three classes which OSHA or ACGIH treat

separately, but NIOSH treats the same. These are cadmium, which OSHA separates into dust and fume;

PCBs, which are divided by the percent of chlorine

present; and the explosive nitro compounds, nitroglycerin and ethylene glycol dinitrate. Finally, 10 NIOSH

recommendations cover exposures to general categories of toxic substances or harmful physical agents,

while 5 others cover hazardous working conditions.

These are described in chapter 12, but because most

of them are not easily compared on a numerical basis,

they were excluded from this comparison. Thus the

total number of Protective Levels compared equals 74

plus 43 plus 6 or 123.

Table A-13 presents the numerical Protective Levels

from OSHA, NIOSH, and ACGIH that were com-
3$2 ● Preventlng Illness and Injury in the Workplace

pared. Alternative chemicals names are not used in

table A-13. In most cases, the name used is the one

NIOSH uses. Abbreviations have been included in

most cases for those substances which have them, and,

in fact, some substances are seldom referred to by their

chemical names, abbreviations being more convenient.

In this table, all protective levels are listed in mg/m3

(milligrams substance/cubic meter of air). Generally,

the protective levels in the actual recommendations

and standards are given in ppm (parts per million) or

mg/m3 or both. For convenience and ease of comparison, all ppm concentrations were converted to mg/m3

using the formula:

(MW X (X) ppm)/24.45 = Y mg/m3

(at 250 C and 760 mm Hg pressure, where MW = Molecular

Weight).

Table A-13 lists 123 toxic and hazardous substances

and the corresponding Time-Weighted Average

(TWA) and Ceiling permissible exposure limits for

each substance that are recommended by NIOSH and

ACGIH, and mandated by OSHA. The 123 chemicals

included in the comparison are all those that appear

on the NIOSH list that also appear on either the OSHA

or ACGIH lists. The names of the NIOSH list substances that were left out for various reasons are listed

in the Notes (No. 36).

When there is only one exposure limit in a protective level the word “none” in small letters indicates

which exposure limit is not part of the standard. For

example, “none” under the NIOSH Ceiling Limit for

carbaryl means that the NIOSH recommendation does

not have a Ceiling exposure limit for carbaryl, but it

does have a TWA exposure limit. When there is no

recommendation or standard for a particular substance, the word “NONE” is capitalized and present

in both exposure limit columns.

Approaches differ among OSHA, NIOSH and

ACGIH. For example, many of NIOSH’s recommendations are based on a lo-hour workday and not an

8-hour workday as are OSHA’s PELs. For this comparison, it was assumed that this difference would have

only a negligible effect on the level of protection.

For most substances, NIOSH recommends only one

TLV (98 cases out of 131), either a TWA or a Ceiling

Limit, but not both. OSHA has only one PEL, an 8-

hour TWA, for most of the substances it covers. On

the other hand, ACGIH recommends both a TWA and

a Ceiling TLV in over half of the cases included in this

comparison (73/131). With differing specifications

concerning the type of Protective Level, it can be difficult to compare them. In addition, recommendations

that no exposure be allowed for carcinogens is often

not reflected in the numerical levels recommended by

an organization.

There are also differences in defining specific substances since some descriptions are more inclusive than

others. For example, ACGIH has four TLVs for asbestos (one for each type), while NIOSH has a single

protective level. A similar problem occurs if the substances being compared are not exactly the same, or

if related substances are grouped differently, then the

standards limiting exposure will differ. An example of

this is the different exposure limits for soluble chromium, insoluble chromium, chromous salts, and

chromic acid. These are detailed in the notes to table

A-13.
App. A—Supplemental Information on OSHA and NIOSH 363

o

I
364 . preventing Illness and Injury in the Workplace

0

\
—— . —

App. A—Supplemental Information on OSHA and NIOSH ● 365

Table A-3.—Court Cases Involving OSHA Health Standards*

Access to Employee Exposure arid Medical Records-Louisiana Chemical Association et al. v. Bingham et al.—Fifth

Circuit Court of Appeals remanded this case to the U.S.

District Court for the Western District of Louisiana 657

F. 2d. 777 (5th Cir., 1981). District Court affirmed the standard, 550 F. Supp 1136 (1982); Fifth Circuit Court of Appeals

affirmed, without opinion, the decision of the District

Court (May 16, 1984).

Acryionitrile— Vistron v. OSHA (6th Cir., Mar. 28, 1978), emergency temporary standard contested, request for stay of

standard was denied, 6 OSCH 1483. The petition for review

was then withdrawn.

Arsenic (lnorganic)–ASARCO Inc. et al. v. OSHA, 746 F.2d

483 (9th Cir., Sept. 13, 1984)-Court remanded arsenic

standard to OSHA (Apr. 7, 1981). After OSHA developed

a risk assessment to comply with the Supreme Court’s

ruling in the Benzene case, the Ninth Circuit Court of Appeals affirmed the arsenic standard.

Asbestos—industrial Union Department, AFL-CIO v.

Hodgson, 499 F.2d 467, (D.C. Cir., Apr. 15, 1974)—Affirmed

OSHA’s 1972 asbestos standard.

Asbestos— Asbestos Information Association/North America v. OSHA, 727 F.2d. 415 (5th Cir., Mar. 7, 1984)-Vacated

the emergency temporary standard issued on Nov. 4, 1983.

Benzene–American Petroleum Institute v. OSHA, 581 F.2d

493 (5th Cir., Oct. 5, 1978); Industrial Union Department,

AFL-CIO v. American Petroleum Institute, 448 U.S. 807 (Supreme Court, July 2, 1980)-Both the 5th Circuit Court of

Appeals and the Supreme Court vacated the OSHA benzene standard, although for different reasons.

Cancer Policy—American Petroleum Institute, et al. v. OSHA,

et al., Nos. 80-3018, et al. (5th Cir., pending).

Coke Oven Emissions—American Iron & Steel Institute v.

OSHA, 577 F.2d 825 (3d Cir., Mar. 28, 1978)—Third Circuit

Court of Appeals largely affirmed the Coke Oven Emissions standard. The Supreme Court agreed to review this

decision, but the request for review was withdrawn before

the case could be heard. 448 U.S. 917 (1980)

Cotton Dust—AFL-CIO v. Marshall, 617 F.2d 636 (D.C. Cir.,

Oct. 10, 1979); American Textile Manufacturers Institute,

Inc. v. Donovan, 452 U.S. 490 (June 17, 1981)-D.C. Court

of Appeals and the Supreme Court both upheld the major requirements of the cotton dust standard as applied

to the textile industry.

Cotton Dust–Cotton Warehouse Association v. Marshall, 449

U.S. 809 (Oct. 6, 1980)-Supreme Court granted a petition

for review and vacated the decision of the court of appeals

with respect to the warehousing and classing segments

of the industry.

Cotton Dust—Texas Independent Ginners Association v. Marshall, 630 F.2d 398 (5th Cir., November 14, 1980)-Vacated

cotton dust standard as applied to cotton ginning operat ions.

Ethylene Oxide—Public Citizen Health Research Group, et

al. v. Auchter, 554 F. Supp. 242 (D.C. District Court, Jan.

Court Cases Involving

Lavatories for Industrial Employment-Associated industries

of New York State, Inc. v. Department of Labor, et al., 487

F.2d 342 (2d Cir., Oct. 4, 1973)—The Second Circuit Court

of Appeals vacated the OSHA lavatory standard.

Mechanical Power Presses-AFL-CIO v. Brennan, 530 F.2d

5, 1983). Public Citizen’s Health Research, et al,, v.

Auchter, et al., 702 F.2d. 1150 (D.C. Cir., Mar. 15, 1983)–

Public Citizen requested a court order compelling OSHA

to issue an emergency temporary standard. The District

Court decided to issue such an order. The case was appealed to the D.C. Court of Appeals, which refused to order that an emergency temporary standard be issued, but

did order that OSHA expedite its section 6(b) rulemaking.

Fourteen Carcinogens—Dry Color Manufacturing Association v. Department of Labor, 486 F.2d 98 (3d Cir., Oct. 4,

1973)—Vacated the emergency temporary standard for

two of the fourteen carcinogens.

Fourteen Carcinogens-Synthetic Organic Chemical Chemical Manufacturers Association v. Brennan, 503 F.2d 1155

(3d Cir., Aug. 26, 1974)–Affirmed standard for ethyleneimine under the 14 Carcinogens standard (SOCMA l).

A petition for rehearing was denied Oct. 6, 1975. The Supreme Court denied a request for review, 420 U.S. 973 (Mar.

17, 1975).

Fourteen Carcinogens-Synthetic Organic Chemical Manufacturers Association v. Brennan, 506 F.2d 385 (3d Cir.,

Dec. 17, 1974)—Third Circuit Court of Appeals vacated the

standard for MOCA (1 of the 14 carcinogens) (SOCMA II).

The Supreme Court denied a request for review. Oil, Chemical and Atomic Workers International Union, AFL-CIO v.

Dunlop, 423 U.S. 830 (Oct. 6, 1975).

Hazard Communication (Labelling--United Steelworkers of

America, Public Citizen, State of Massachusetts, Fragrance Materials Association, People of the State of IIiinois, Flavor& Extract Manufacturing Association, State

of New York v. Auchter, Nos. 83-3554, 83-3561, 83-3565,

84-3066, 84-3087, 84-3093, 84-3117, 84-3128 (3d Cir.,

pending).

Occupational Noise Exposure/Hearing Conservation

Amendment —Forging Industry Association v. Sec. of Labor No. 83-1232 (4th Cir., Nov. 7, 1984)-Fourth Circuit

Court of Appeals vacated the Hearing Conservaton

Amendment.

Lead–United Steelworkers of America v. Marshall, 647 F.2d

1189 (D.C. Cir., Aug. 15, 1980)-The D.C. Court of Appeals

affirmed the lead standard in part, but directed OSHA to

determine the feasibility of engineering controls for 38 industries and occupations. The Supreme Court denied a

request for review Lead Industries Association, Inc. v.

Donovan, 453 U.S. 913 (1981)

Pesticides—Florida Peach Growers Association, Inc. v. Department of Labor, 489 F.2d 120 (5th Cir., Jan. 9, 1974)–

The Fifth Circuit Court of Appeals vacated the emergency

temporary standard for pesticides.

Vinyl Chloride-Society of the Plastics Industry, Inc. v. OSHA,

509 F.2d 1301 (2d Cir., Jan, 31, 1975)—The Second Circuit

Court of Appeals affirmed the vinyl chloride standard. The

Supreme Court denied a request for review Firestone

Plastics Co. v. U.S. Department of Labor 421 U.S. 992 (May

27, 1975).

OSHA Safety Standards

109 (3d Cir., Dec. 31, 1975)–The Third Circuit Court of Appeals remanded to OSHA for a new statement of reasons

and then affirmed OSHA’s changes to the “no hands in

die” standard.

Commercial Diving Operations— Taylor Diving and Salvage
366 ● Preventing Illness and injury in the Workplace

Table A-3.—Continued

v. U.S. Department of Labor 537 F.2d 819 (5th Cir.,1976)—

Court issued an indefinite stay of the ETS for commercial diving.

Commercial Diving Operations– Taylor Diving and Salvage

v. U.S. Department of Labor 599 F.2d 622 (5th Cir., July

16, 1979)—Vacated the medical requirements section (29

CFR 1910,411) of the final standard for commercial diving.

Diving Exemptions-United Brotherhood of Carpenters and

Joiners of America, AFL-CIO v. U.S. Department of Labor,

No. 82-2509, D.C. Cir,, Apr. 4, 1984)-After oral argument,

court remanded case to OSHA for additional information.

Ground-Fault Protectlon--National Constructors Association

v. Marshall 581 F.2d. 960 (D.C. Cir., June 28, 1978)—The

Court of Appeals for the D.C. Circuit remanded the record to OSHA with specific instruction to consult the Advisory Committee.

Fire Protection-Fim Equipment v. Marshall 679 F.2d 679 (7th

Cir., May 27, 1982)-case was dismissed for lack of standing. Request for rehearing was denied (July 22, 1962).

Industrial Slings--Bethlehem Steel Corp. v. Dunlop 540 F.2d,

157 (3d Cir., Feb. 11, 1976)—Vacated one paragraph of the

standard (29 CFR 1910.184) and remanded the standard

to the Secretary of Labor.

Marine Terminals--National Grain and Feed Association (D.C.

Cir., pending).

“NOTES: F.2d—FederaJ Reporter, Second Series.

U. S.–U.S. Supreme Court Reports.

F. Supp.—Federal Supplement.

Table A-4.-Safety and Health Inspections

Faderal OSHA:

Establishment Safety Safety Health Health Employees covered

inspections inspections inspections inspections inspections by inspections

Fiscal year (number) (number) (percent) (number) (percent) (number)

1973 . . . . . . . . . . . . 48,409 45,225 93.4 ”/0 3,184 6.6% 5,440,303

1974 . . . . . . . . . . . . 77,142 73,189 94.9 3,953 5.1 6,448,067

1975 ....., . . . . . . 80,978 75,459 93.2 5,519 6.8 6,180,881

1976 . . . . . . . . . . . . 90,482 82,885 91.6 7,597 8.4 6,601,729

1977 . . . . . . . . . . . . 60,004 50,892 84.8 9,112 15.2 5,285,946

1978 . . . . . . . . . . . . 57,278 46,621 81.4 10,657 18.6 4,522,582

1979 ......., . . . . 57,734 46,657 80.8 11,077 19.2 4,262,749

1980 . . . . . . . . . . . . 63,404 51,565 81.3 11,839 18.7 3,690,993

1981 . . . . . . . . . . . . 56,994 46,236 81.1 10,758 18.9 2,672,129

1982 . . . . . . . . . . . . 52,818a

43,609 82.6 9,209 17.4 2,235,823

1983 . . . . . . . . . . . . 58,516b

48,269 82.5 10,247 17.5 2,925,049

1984 (Oct. -Mar.) . . 30,606c

25,086 82.0 5,520 18.0 1,552,120

State programs:

Establishment Safety Safety Health Health Employees covered

inspections inspections inspections inspections inspections by inspections

Fiscal year (number) (number) (percent) (number) (percent) (number)

1976d 

. . . . . . . . . . . 166,612 144,780 86.9 21,832 13.1 7,078,294

1977 143,469 130,643 91.1 12,826 8.9 6,000,009

1978 . . . . . . . . . . . . 122,761 112,446 91.6 10,255 8.4 5,739,574

1979 . . . . . . . . . . . . 107,636 99,509 92.4 8,127 7.6 4,932,303

1980 . . . . . . . . . . . . 106,191 98,829 93.1 7,288 6.9 4,340,266

1981 . . . . . . . . . . . . 108,376 99,303 91.6 9,073 8.4 4,404,364

1982 . . . . . . . . . . . . 92,942 84,570 91.0 8,372 9.0 3,464,146

1983 . . . . . . . . . . . . 103,879e

93,406 89.9 10,473 10.1 3,818,287

1984 (Oct. -Mar.) . . 51,072f

46,065 90.2 5,007 9.8 1,858,114

a-s not ~nclude 8,444 “ReCO@i Review” inspections in ftscal Year 1962.

b-s not Include 1(),402 “Records Review” inspections in fiSCa\ Year 19M.

cooes not include 4,9s4 ‘“R~ords Review” inspections during the first 6 months (Oct. -Mar.) Of fisCal year 1964.

dNo data available prior to 19

76

estate data d~s not Include 2,554 “Records Reivew” inspections in fiScal Year f~.

fstate dat a dogs not include 1,~ ‘, Records Review” ~ns~ctions during the first 6 months (Oct,-Mar.) of fiSCal year 1964,

SOURCE’ Office of Technology Assessment, based on data supplied by OSHA.
— —

App. A—Supplemental Information on OSHA and NIOSH ● 367

Notes to Tables A-4 Through A-11.-State Program Data
Table A-5-Types of Inspection

State programs

Establishment Fatality/

inspection catastrophe catastrophe Complaint Complaint Programed Programed Follow-up Follow-up

Fiscal year (number) (number) (percent) (number) (percent) (number) (percent) (number) (percent)

1976 . . . . . . . . . . 166$612 4,278 2.6% 13,966 8.4% 119,120 71.5% 29,216 17.5%

1977 . . . . . . . . . . 143,469 3,652 2.5 14,404 10.0 101,571 70.8 23,842 16.6

1978 . . . . . . . . . . 122,761 4,609 3.8 15,467 12.6 81,762 66.6 20,923 17.0

1979 . . . . . . . . . . 107,636 5,181 4.8 15,285 14.2 70,762 65.7 16,408 15.2

1980 . . . . . . . . . . 106,191 5,264 5.0 13,823 13.0 72,899 68.6 14,168 13.3

1981 . . . . . . . . . . 108,376 5,259 4.9 14,365 13.3 75,839 70.0 12,858 11.9

1982 . . . . . . . . . . 92,942 4,663 5.0 10,721 11.5 68,100 73.3 9,455 10.2

1963 . . . . . . . . . . 103.879 5.366 5.2 11.623 11.2 78.796 76.0 8.094 7.8

1984 (Oct.-Mar.).. 51,072 2,849 5.6 5,754 11.3 39,085 76.5 3,384 6.6

SOURCE:OtfkeofToch_A 8$e88mmt,ba8edoncW88upplledbyOSHA.
App. A–Supplemental In formation on OSHA and N!OSH ● 369
Eatdmtwnent

inspections

Flacal Year (numbed

1973 . . . . . . . . .

-48.409.

1974 . . . . . . . . .

1975 . . . . . . . . .

1976 . . . . . . . . .

1977 . . . . . . . . .

1978 . . . . . . . . .

1979 . . . . . . . . .

la m . . . . . . . .

1981 . . . . . . . . .

1882 . . . . . . . . .

1963 . . . . . . . . .

1964(oct.-Mar.)

77;142

80,978

::E

57~78

57,734

63,404

:’RI

$%6

Inapeotlonswith

lnapection8with tnapectionatith Inspectionswlth other~a

Seriousviolatfons willful violations reoe8tvtolations Yiolutions

(number) (percent) (numberj (percent) (number) (percent) (number) (percant)

1,535

:s

5*W6

11,0%?

14,620

16,624

19,358

16~7

12,852

14#86

8.156

3.2%

3-5

4.1

6.6

18.5

25.5

m.5

28.5

24.3

25.4

26.7

z

104

153

169

428

587

241

86

105

65

0.0%

:::

0.2

0.3

0.7

1.0

0.9

::

0.1

02

2

1,175

2 a

2,356

&191

2#3

2s)21

1,318

810

1#132

610

0.1%

0.6

1.5

2.4

3.9

3.8

3.9

3.2

2.3

1.5

$.7

2.0

23,814

48#24

50,985

59$)81

31,126

25~7

25,068

27,366

X$717

26,187

30,472

15201

49.2%

62.3

63.0

65.3

51.9

U.1

43.4

432

46.9

49.6

52.0

48.7

In$pectionu

conteste d

(number) (percent)

1,3

2,4

3,1

5,0

4,2

:;

7,3

&5

1,4

1,1

5

5

17

la

t7

0

‘4

13

n

t2

‘o

k2

u

2.7%

3.2

3.9

5.5

7.0

9.6

11.6

11.7

6.3

28

1.9

1.9

Esttiishment

-~

htapectiata hwpections contested

Fiaod year (number) (number) (-)

1876 . . . . . . . . . . 166,612 &277 3.8%

10?7 . . . . . . . . . . 143#68 5,024 3.5

1878. . . . . . . . . . 1~761 4,703 3.8

1979 . . . . . . . . . . lo7,m 5,171 4.8

1860 . . . . . . . . . . 106,191 CompanMe data for state programs ara not readily available 4,308 4.1

IWI . . . . . . . . . . 166#76 4,452 4.1

1862 . . . . . . . . . . %2,842 3* 3.5

1W3 . . . . . . . . . . 103,878 3,322

1964 (oCt.-Mar.) 51,072 1,686 :;

80URCE: Offia of 1~~t,~ on -s sw@iod by OSHA.
App. A—Supplemental Information on OSHA and NIOSH . 371

. . .

, . .

. , .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . . . .

..., .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

..!. ,

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

.

. . . .

.., .

.., .

. . . .

. . . .

,.. .

. . . .

.., .

. . . .

. . . .

. . . .

. . . .

,.. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

. .

, .

. .

. .

. .

. .

. .

. .

. .
372 Preventing Illness and Injury In the Workplace

. . . .

. . . .

. . . .

.,, .

. . . .

. . . .

. . . .

. . . .

.., .

,,, ,

. . . .

.., .

. . . .

. . . .

.., .

.., .

. . . .
App. A—Supplemental Information on OSHA and NIOSH 373

U

T-F 7-
374 . Preventing Illness and Injury In the Workplace

Table A-11.--Average Proposed Penalties

Federal OSHA

Violations

Other-than

Serious Willful Repeat serious

(average (average (average (average Average penalty Average penalty

Fiscal year penalty) penalty) penalty) penalty) per inspection per violation

1973 . . . . . . . . . . . . 631 5,805 1,349 45 78 26

1974 ......., . . . . 576 2,706 247 41 84 22

1975 . . . . . . . . . . . . 541 2,538 228 42 93 24

1976 . . . . . . . . . . . . 545 3,081 207 42 124 30

1977 . . . . . . . . . . . . 290 2,990 242 61 158 52

1978 . . . . . . . . . . . . 285 3,460 429 88 259 111

1979 . . . . . . . . . . . . 273 3,750 429 94 291 131

1980 . . . . . . . . . . . . 255 3,244 478 110 280 135

1981 . . . . . . . . . . . . 209 3,660 90 177 91

1982 . . . . . . . . . . . . 195 4,364 320 86 104 57

1983 . . . . . . . . . . . . 177 4.555 346 74 179 257

1984 (Oct.-Mar.) . . 187 4;977 408 101 211 68

State programs

Violations

Other-thanSerious willful Repeat serious

(average (average (average (average Average penalty Average penalty

Fiscal year penalty) penalty) penalty) penalty) per inspection per violation

1976, . . . . . . . . . . . 420 3,615 115 33 39 15

1977, . . . . . . . . . . . 293 2,487 100 39 35

1978. . . . . . . . . . . . 210 3,174 197 68 51

1979. . . . . . . . . . . . 239 2,869 251 74 76 30

1980 . . . . . . . . . . . . 248 3,592 253 63 75 33

1981 . . . . . . . . . . . . 211 3,156 450 75 65 30

1982 . . . . . . . . . . . . 201 3,146 230 101 54 26

1963 . . . . . . . . . . . . 167 3,112 191 139 68 31

1984 (Oct.-Mar.) . . 176 4,055 213 138 73 34

SOURCEOfflceof Technology Assessment, based on data suppliedby OSHA,
Table A-12.—Occupational Safety and Health: Coverage of Workers

Agency Type of workers covered Number of workers covered Basis for agency authority Comments

Department of Labor

Occupational Safety and Health

Administration (OSHA) and

State Programs approved by

OSHA . . . . . . . . . . . . . . . . . . . . . 75,031 ,OOOa (1979 estimate) Occupational Safety and Health

Act of 1970

In some cases, another Federal

agency is responsible for only

certain aspects of safety and

health, and the same workers

may be covered by OSHA for

the remaining aspects (see e.g.,

NRC in this table)

All employees and working

conditions except: Federal

employees, and those covered

by other governmental

agencies according to other

statutes

Mine Safety and Health

Administration (MSHA). . . . . . . Federal Mine Safety and Health

Act of 1977

Coal, metal and nonmetal

mining workers. All employees

on mine property are covered

467,095 (1 2 preliminary

b

estimate)

Dapartment of Transportation:

Bureau of Motor Carrier Safety

(BMCS) (Federal Highway

Administration) . . . . . . . . . . . . . Approximately 4.5 millionc

Interstate Commerce Act Does not include workers in repair

garages, or workers on loading

docks, who are all covered by

OSHA

Employees in, on, or about

motor vehicles engaged in

interstate commerce

Federal Aviation Administration

(FAA) . . . . . . . . . . . . . . . . . . . . . Coverage of ground crews is the

focus of a dispute between the

FAA and OSHA

Approximately 170,000d All flight crews; ground crews Federal Aviation Act of 1956

and mechanics during some

activities

Federal Railroad Administration

(FRA) . . . . . . . . . . . . . . . . . . . . . . All operating employees, i.e.,

employees on rolling stock

plus certain railroad yard

employees

Seamen on Coast Guardinspected and certificated

vessels

143,617 (1979 preliminary

estimate) e

About 100,000f (1963 estimate)

Federal Railroad Safety Act of

1970

The Marine Safety Laws OSHA has jurisdiction over

shipyard workers and

longshoremen

U.S. Coast Guard. . . . . . . . . . . . . .

Other Federal Agencies:

Department of Energy (DOE). . . . DOE has adopted OSHA’s health

and safety regulations; DOE

does not cover employees

during initial construction of

facilities

116,323 g (1962 estimate) Atomic Energy Act of 1954, as

amended

Employees in Governmentowned contractor operator

(GOCO) facilities, e.g., those

involved in research in nuclear

energy, weapons research and

production, production of

enriched uranium.

Nuclear Regulatory Commission

(NRC) . . . . . . . . . . . . . . . . . . . . . . NRC covers only radiation

hazards; OSHA is responsible

for all other safety and health

aspects. NRC licenses State

plans in some States, similar to

OSHA State Programs

327,350 h (1979 estimate) Atomic Energy Act of 1954, as

amended

Workers exposed to radiation

hazards from materials

licensed by the NRC,

including: 1) source material

(uranium and thorium); 2)

special nuclear material

(material capable of being

fissioned); 3) by-products of a)

fission; and b) tailings from

uranium ore processing
. .

Table A-12.—Occupational Safety and Health: Coverage of Workers-Continued

Agency Type of workers covered Number of workers covered Basis for agency authority Comments

Federal Government

departments and independent

agencies . . . . . . . . . . . . . . . . . . . Each covers its own federally- 6,271,736i

(fiscal year 1962) Occupational Safety and Health Agency programs must be

employed workers. Act of 1970 “consistent with” occupational

safety and health standards

Environmental Protection

promulgated by OSHA

Agency . . . . . . . . . . . . . . . . . . . . Mixers, loaders, and applicators Federal Insecticide, Fungicide, For mixers, loaders and

of pesticides; farm field and Rodenticide Act applicators, protection from

workers pesticide exposure is through

labeling requirements. OSHA

has jurisdiction for other health

and safety aspects of these

jobs.

%fflce of Statistical Studies and Analysis, OSHA. Includes all private-sector employees covered directly by Federal OSHA and State Programs.

bperwn~ communication, MSHA, Mar. 3, l=.

cper~ond communication, BM~.

dpersoal commun ications: Air Transport Association and Regional Aifllne Association

eyea~k of R&”/o@ Facts, June 1~.

fperWnal communication, U.S. ~~t GIJWd.

gDOE, Rep@ of Emp/Oymerrt &@ Labor Turnover, Sept. 30, 19E2.

hNRC ‘+occupation~ Radiation Exposure, Twelfth AnnUa/ Repofi, ~gT9 (l~z).

Ius, ~epa~menr of L~r, Fadera/ Compliance ActMty Ftepofl, Jan. 4, 1~

SOURCE: Office of Technology Assessment.
—

App. A—Supplemental Information on OSHA and NIOSH ● 377

Table A-13. -Analyses of OSHA, NIOSH, and ACGIH Protective Levels

OSHA OSHA NIOSH NIOSH ACGIH ACGIH

TWA ceiling TWA (1) ceiling TWA ceiling

Substance (notes) (36) mg/m3 mg/m3 mg/m3 mg/m3 mg/m3 mg/m3

Acetylene (10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,662 2,662 NONE NONE

Acrylamide (35) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Acrylonitrile (11) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Aldrin/Dieldrin (12,27,35) . . . . . . . . . . . . . . . . . . . . .

Alkanes: (14)

Pentane . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hexane . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Heptane . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Octane . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Allyl chloride . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ammonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antimony . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Arsenic, inorganic compounds . . . . . . . . . . . . . . . .

Asbestos (9).... . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Asphalt (petroleum) fumes . . . . . . . . . . . . . . . . . . .

Benzene (2,16) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Benzoyl peroxide . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Benzyl chloride . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Beryllium (2,16) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Boron trifluoride (13,15) . . . . . . . . . . . . . . . . . . . . . .

Cadmium, fume (2,23). . . . . . . . . . . . . . . . . . . . . . . .

dust (2,23) . . . . . . . . . . . . . . . . . . . . . . . .

Carbaryl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Carbon black (18) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Carbon dioxide (17). . . . . . . . . . . . . . . . . . . . . . . . . .

Carbon disulfide (2) . . . . . . . . . . . . . . . . . . . . . . . . .

Carbon monoxide . . . . . . . . . . . . . . . . . . . . . . . . . . .

Carbon tetrachloride (2,16) . . . . . . . . . . . . . . . . . . .

Chlorine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chloroform (15,16). . . . . . . . . . . . . . . . . . . . . . . . . . .

Chloroprene (35) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chromium (VI), water soluble(3) . . . . . . . . . . . . . .

Chromium (VI), insoluble (3) . . . . . . . . . . . . . . . . . .

Coal tar products (5). . . . . . . . . . . . . . . . . . . . . . . . .

Cotton dust(6).. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cresol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cyanide (17,35) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DDT (26,37,35) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

l,2-dibromo-3-chloropropane (DBCP) (16,34) . . . . .

Diisocyanates:

Toluene-2,4-diisocyanate (15) . . . . . . . . . . . . . . .

Diphenylmethane diisocyanate (13,15). . . . . . . .

Isophorene diisocyanate . . . . . . . . . . . . . . . . . . .

Dinitro-ortho-cresol (35) . . . . . . . . . . . . . . . . . . . . . .

Dioxane (35)..... . . . . . . . . . . . . . . . . . . . . . . . . . . .

Epichlorohydrin (35) . . . . . . . . . . . . . . . . . . . . . . . . .

Ethylene dibromide (2) . . . . . . . . . . . . . . . . . . . . . . .

Ethylene dichloride (2) . . . . . . . . . . . . . . . . . . . . . . .

Ethylene oxide (27,37) . . . . . . . . . . . . . . . . . . . . . . .

Fibrous glass, (dust) (29) . . . . . . . . . . . . . . . . . . . . .

Fluorides, inorganic(2) . . . . . . . . . . . . . . . . . . . . . .

Formaldehyde (2,13,16). . . . . . . . . . . . . . . . . . . . . . .

Furfuryl alcohol ........, . . . . . . . . . . . . . . . . . . . .

Glycidyl ethers:

Allylglycidyl ether (15) . . . . . . . . . . . . . . . . . . . . .

n-Butyl glycidyl ether . . . . . . . . . . . . . . . . . . . . . .

Di-2,3-epoxypropyl ether (diglycidyl ether)

(DIE) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Isopropyl glycidyl ether . . . . . . . . . . . . . . . . . . . .

Phenylglycidyl ether (PAGE ) . . . . . . . . . . . . . . . .

0.3

4.3

0.25

2,945

1,800

2,000

2,350

3

0.01

2

NONE

32

5

5

0.002

none

0.1

0.2

5

3.5

9,000

62

55

63

none

none

90

0.5

1

0.2

0.2

22

5

0,0096

none

none

NONE

0.2

20

154

202

90

15

2.5

3.7

none

270

none

240

60

none

none

21.7

none

none

none

none

none

none

none

none

none

10

NONE

80

none

none

0.005

3

0.3

0.6

none

none

none

93

none

157

3

240

none

none

none

none

none

none

none

none

none

0.14

0.2

NONE

none

none

none

230

405

none

none

none

6

none

45

none

2,8

none

none

none

0.3

none

0.15

350

350

350

350

3.1

none

0.5

none

0.1

none

none

5

none

0.0005

NONE

0.04

0.04

5

3.5

18,000

3

40

none

none

none

none

0.025

0.001

0.1

0.2

10

none

0.5

none

0.035

0.05

0.045

0.2

none

2

none

5

2.5

none

none

none

none

none

none

0.3

4.5

0.25

1,800

180

1,600

1,450

3

0.2

2

5

5

0.002

none

0.05

0.05

5

3.5

9,000

30

55

30

3

50

45

0.05

0.05

0.2

0.2

22

5

1

none

0.04

none

0.09

0.2

90

10

none

40

2

10

2.5

1.5

40

22

135

0.5

240

6

0.6

none

0.75

2,250

none

2,000

1,800

6

27

none

none

none

10

75

none

none

none

3

0.2

0.2

10

27,000

none

125

9

225

none

none

none

none

none

none

none

3

none

0.15

0.2

none

0.6

20

none

60

none

none

none

3

60

44

none

none

none
378 ● Preventing Illness and Injury In the Workplace

Table A-13.--Analysis of OSHA, NIOSH, and ACGIH Protective Levels

OSHA OSHA NIOSH NIOSH ACGIH ACGIH

TWA ceiling TWA (1) ceiling TWA

Substance (notes) (36)

ceiling

mg/m3 mg/m3 mg/m3 mg/m3 mg/m3 mg/m3

Hydrszines: (16)

Hydrazine (16,35) . . . . . . . . . . . . . . . . . . . . . . . . . .

1,1-Dlmethyl hydrazine (16,35), . . . . . . . . . . . . . .

Phenyl hydrazine (16,35) . . . . . . . . . . . . . . . . . . . .

Methyl hydrazine (13,15,16,35). . . . . . . . . . . . . . .

Hydrogen fluoride (2) . . . . . . . . . . . . . . . . . . . . . . . .

Hydrogen sulfide (2,17) . . . . . . . . . . . . . . . . . . . . . .

Hydroquinone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

isopropyl alcohol. . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ketones:

Acetone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Methyl ethyl ketone (MEK) . . . . . . . . . . . . . . . . .

Methyl n-propyl ketone . . . . . . . . . . . . . . . . . . . .

Methyl n-butyl ketone. . . . . . . . . . . . . . . . . . . . . .

Methyl n-amyl ketone . . . . . . . . . . . . . . . . . . . . . .

Methyl isobutyi ketone.. . . . . . . . . . . . . . . . . . . .

Methyl isoamyl ketone (20) . . . . . . . . . . . . . . . . .

Diisobutyl ketone . . . . . . . . . . . . . . . . . . . . . . . . .

Cyciohexanone . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mesityl oxide... . . . . . . . . . . . . . . . . . . . . . . . . . .

Diacetone alcohol. . . . . . . . . . . . . . . . . . . . . . . . .

lsophorone (13) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lead, inorganic (33) . . . . . . . . . . . . . . . . . . . . . . . . .

Malathion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mercury, inorganic (2,4,24). . . . . . . . . . . . . . . . . . . .

Methyl alcohol.. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4,4-Methylene-bis-2-chloroaniline (MOCA) (8,27)..

Methyl parathion . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Methylene chloride (2,19) . . . . . . . . . . . . . . . . . . . . .

Nickel carbonyl (27) . . . . . . . . . . . . . . . . . . . . . . . . .

Nickel, inorganic and compounds . . . . . . . . .

Nitric acid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nitrides:

Acetonitrile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tetramethyl succinonitrile. . . . . . . . . . . . . . . . . .

Nitrogen, oxides NO2

: (15) . . . . . . . . . . . . . . . . . . . .

(Nitric oxide) NO: . . . . . . . . . . . . . . . . . . . . . . . . .

Nitroglycerin (15,16) . . . . . . . . . . . . . . . . . . . . .

Ethylene glycol dinitrate (15). . . . . . . . . . . . . . . .

Parathion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phenol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phosgene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Polychlorinated biphenyls: (35)

Chlorodiphenyl (42%). . . . . . . . . . . . . . . . . . . . . .

Chlorodiphenyl (54%). . . . . . . . . . . . . . . . . . . . . .

Refined petroleum solvents (7). . . . . . . . . . . . . . . .

Silica (quartz, respirable dust) . . . . . . . . . . . . .

Sodium hydroxide (13) . . . . . . . . . . . . . . . . . . . . . . .

Sulfur dioxide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sulfuric acid.... . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1,1,2,2-Tetrachloroethane (35) . . . . . . . . . . . . . . . . .

Tetrachloroethylene (2). . . . . . . . . . . . . . . . . . . . . . .

Thiols: (21)

Butyl mercaptan . . . . . . . . . . . . . . . . . . . . . . . . . .

Methyl mercaptan (15) . . . . . . . . . . . . . . . . . . . . .

Ethyl mercaptan (15). . . . . . . . . . . . . . . . . . . . . . .

Tin, organic compounds . . . . . . . . . . . . . . . . . . . . .

o-Toluidine (35) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Toluene (2,17)... . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1,1,1-Trichloroethane . . . . . . . . . . . . . . . . . . . . . . . .

Trichloroethylene (2) . . . . . . . . . . . . . . . . . . . . . . . . .

1.3

1

22

none

2.45

none

2

2,400

590

700

410

465

410

NONE

290

140

0.05

15

0.1

NONE

NONE

1,736

0.007

1

5

70

3

none

30

none

none

0.1

19

0.4

1

2,950

0.098

2

3

1

35

none

none

0.1

22

753

1,900

536

none

none

none

0.35

none

16

none

none

none

none

none

none

none

none

NONE

none

none

none

none

none

none

none

none

none

NONE

NONE

3,476

none

none

none

none

none

9

none

2

1

none

none

none

none

none

none

none

none

none

none

none

1,358

none

20

25

none

none

1,129

none

1,072

none

none

none

none

2.5

none

none

984

590

590

530

4

465

200

230

140

100

40

240

23

0.1

15

0.05

262

0.003

0.2

261

0.007

0.015

5

34

none

none

30

none

none

0.05

20

0.4

0.001

0.001

350

0.05

none

1.3

1

6.87

339

1.8

1

1.3

0.1

none

375

none

134

0.04

0.15

0.6

0.08

5

15

2

1,968

none

none

none

none

none

none

none

none

none

none

none

none

none

none

none

1,048

none

none

1,740

none

none

none

none

6

1.8

none

0.1

0.1

none

none

none

1,800

none

2

none

none

none

678

none

none

none

none

0.02

750

1,190

none

0.1

none

2.5

14

9 2

1,780

590

700

20

235

205

240

150

100

60

240

none

0.15

10

0.1

260

0.22

0.2

350

0.35

0.1

5

70

3

6

30

0.5

0.3

0.1

19

0.4

1

0.5

NONE

0.1

none

5

1

7

335

1.5

1

1

0.1

9

375

1,900

270

none

2

45

0.35

5

21

4

1,225

2,375

885

875

none

465

300

none

none

400

100

360

25

0.45

none

none

310

none

0.6

1,740

none

0.3

10

105

9

10

45

0.3

38

none

2

1

NONE

none

2

10

none

35

1,340

none

none

3

0.2

none

2,450

1,080
App. A–Supplemental Information on OSHA and NIOSH ● 379

Table A-13.-Analysis of OSHA, NIOSH, and ACGIH Protective Levels—Continued

OSHA OSHA NIOSH NIOSH ACGIH ACGIH

TWA ceiling TWA (1) ceiling TWA ceiling

Substance (notes) (36) mg/m3 mg/m3 mg/m3 mg/m3 mg/m3 mg/m3

Tungsten: (31)

insoluble compounds . . . . . . . . . . . . . . . . . . . . . . NONE NONE 5 none 5 10

soluble compounds . . . . . . . . . . . . . . . . . . . . . . . NONE NONE 1 none 1 3

Vanadium, as V2O5 (dust) (15,32) . . . . . . . . . . . . . . none 0.5 none 0.5 0.5 none

(fume) (15,32) . . . . . . . . . . . . . . none 0.1 none 0.05 0.05 none

Ferrovanadium (32) . . . . . . . . . . . . . . . . . . . . . . . . 1 none 1 none 1 3

Vinyl acetate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NON E NONE none 15 30 80

Vinyl halides: (22)

Vinyl bromide . . . . . . . . . . . . . . . . . . . . . . . . . . . . NONE NONE none 4 20 none

Vinyl chloride . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.5 13 none 2.55 10 none

Vinylidene chloride. . . . . . . . . . . . . . . . . . . . . . . . NONE NONE none 4 20 80

Xylene (17) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 435 none 434 868 435 655

Zinc oxide (fume) . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 none 5 15 5 10

SOURCE Office of Technology Assessment

1 NIOSHTWA recommmdahons arebasedon upto alo-hourexposure unlesaotherwse indicated

2 Un&r OSHAregulatlons, the ceiling levekfor these substances are labelkd’’Acmptable CeshngConcmtrahon “hatibon,forea ~oftktids them ~an’’Accqtable Mammum Peak above the acceptable cdmg concentration for an &hour shift, ”

which I]sts a thwd concentration level and maximum duration. Details can be found

m table Z-2 m the OSHA Standards (29 CFR1910,1~).

3 Chrommm (V/)–There are several ways to separate chromium (VI) compounds mto

different classifications The difficulty m comparing the recommendations and standards is that each organization uses different classifications Chromium (VI) can be

classified carcinogenic or not, soluble and nonsoluble, salts, and chromates. Chromic

aod IS chromium (VI) oxide and includes aqueous solutions thereof

The OSHA standard for chromium (VI) separates chromium into “soluble chromic

and chromous salts” and “metal and resoluble salts,” both having differmt PELs. These

values can be found m OSHA table Z-2 There )s a different PEL for chromic acid

and chromates

The 1975 N1OSH criteria document for chromium (VI) revises the 1973 recommendations for Chromic acid Chromic acid (or chromic acid anhydri&) is an oxide of

chrom]um (VI} and IS clas.wfwd as a noncarcusogenic chromium (Vi) Un&r N1OSH

recommendations, there are two recommended standards for chromium (VI) One

standard addresses Occupational exposure to a group of noncarcmogenic, but otherwise hazardous, chromium materials, while the other standard covers occupahonal

exposure to other chrom]um materials that are associated with an increased Incidence

of lung cancer However, there N no practical means of distinguishing between these

two groups on the basis of chemical analysis of airborne materials Until the airborne

chromium in a partscuhr workplace k demonstrated to be of the noncarcincgenic type,

all alrbome chromium IS consmfa-ed to be carcinogenic

ACGIH recommends two standards for chromium (VI) by separating the compounds

into “water soluble” and “certain water insoluble” compounds which are labelledcarcinogenic However, the TLV IS the same for both ty-pes

This companscm table deals with this ambiguity by lwting two standards for

chrom]um(W) water soluble (non-carcinogenic), and resoluble, metal and salts (carcmogenlcl Under the OSHA category, only the chromium values m the table Z-I

are used, chromic acid m table Z-2 IS gnored

4 Mercury Under the OSHA standards, mercury IS listed m table Z-2 The PEL for mercury is 1 mg /10 m

l This IS equal to O 1 mg/m3

5 Coal Tar Products-Protectwe Levels for coal tar products, or coal tar pitch volatiles,

are mwleading and difficult to compare because the methods of measuring ● xposure

levels differ among OSHA, NIOSH, and ACGIH The OSHA PEL addresses the

benzene soluble frachon (anthracme, BaP, phenanthrene, acndme, chrysene and

pyrene), as does the ACGIH recommended TLV The NIOSH recommendation pertains to the cyclohexane extractable fract]on The comparison table contains all the

protectwe levels but direct comparison IS not apphcable in this case.

6 Cotton Dus—OSHA standards for cotton dust are set out in 19101043 of the standards. There are three different standards for three major processes, yam manufacturmg, dashing and weaving, and all other operations. The PEL for yam manufacturing

IS the most stringent, and this IS the protechve level that the compariscm table !Ists

NIOSH has only one standard for cotton dust (described as hnt-free cotton dust).

ACGIH also recommends lust one standard for %nt-free dust According to all three

standards (OSHA, NIOSH, and ACGIH), measurement of the ● xposure level is by

the vertical elutnator cotton dust sampler.

7 Refrned petroleum soluents-OSHA l]sts these substances simply as “petroleum dlshllates (naphtha) “ The N1OSH recommendation controls exposure to petroleum ether,

rubber solvent, vammh makers’ and painters’ naphtha, mineral spirits, Stoddard

solvmts and kerosene The asurrphon is that the recommendation for these substanms

are equivalent and are measured the ~me way

8 4 4 -Methylent--b[s (2-chloroarnl ljne)-The OSHA standard for

4,4 -methylme-bw-2-chloroandme(MOCA), section 1910 1c05, was deleted from the

9

10

11

12

13

14

15

OSHA standarda on August 2s3, 1976 Both N1OSH ● nd ACGIH recommend TWA

protective levels for MOCA.

Asbestos-OSHA, NIOSH, and ACGttf nuasure aafxatoa corrantration by the nurnkr

of fibem longer than s micrornetem per cubic mntimeter of air: e.g., 2 fibem/cc >

5pm in length In the comparison table the numbers ● re listed under mg/ml for ● asy

comparison, but they have not been converted to rng/m~.

OS-IA and NIOSH have one standard for asbestos, while ACGIH divides asbestos

mto four types with different recommendations for ● ach. However, the standard for

cfvysotile (the moat common) is used in the table. The rest of the ACGIH list con.

tains amosite (0.5 fibers/cc > sw in length), crocidolite (0.2 fibers/cc > Sum in

length), and other forms (2 fibers/cc > 5pm in length). ACGIH does not indicate

whether this is a TWA or ceiling TLV recommendation; in the comparison table it

is plad under TWA.

Acetylene-The OSHA PEL for ● cetylene is not in the OSHA health standards list

(29 CFR 1910. IIXM3) but the N1OSH summary booklet does list one; this is the protective Iwel used in the comparison table. There is an added note un&r the OSHA PEL,

“1O percent of lower exposure limit, ” with no further explanation. The NIOSH recommendation for acetylene says, ‘Occupational exposure to ● irborne ● mtylene shall

be controlled so that no employees will b exposed to amtylene at ● concentration

in excess of 2,5oo ppm. This is not the same ● s an “acceptable cAing comtration. ”

However, to allow some comparison among standarda, the recommended TLV is in

the ceiling column. ACGIH classifies amtylene as a simple asphyxiant; a TLV is not

recomrnmded because the limiting factor is the availabk oxygen. ACGLH accutrtpaniea

the desaiption of simple asphyxiants with warnings, including the additional fact that

several simple asphyxiants present an explosive haxard.

Acryfonitrilc The OSHA PEL for ● crylonitrile is in section 191O.1W of the OSHA

standards. In addition to tk TWA and ctilingPELa, the standard states that “tk employer shall aaaure that no employee is exposed to akin contact or eye contact with

liquid ● crylonitrile. ” ACGIH classifies acrylonitrile as a human carcinogen with an

aaaigned TLv,

Aldrirr/~”eldrfn-NIOSH recommends as an exposure level tk ‘lowest reliably detectable lwel; 0.15 mg/mD TWA by NIOSH validated method. ” All three organizations indicate that skin contact u to be avoided.

The TLVS under ACGIH for the following chemicals ● re ● bsolute ceili~ limits, the

concentration of which should not exceed tk ceiling limit even inatantaneossaJy: boron

trifluorick, diphenylmethane diiaocyanate(MDI), methyl hy&azine, iaophorone,

sodium hydroxide, and fonnal&hyde. This fact should be taken into conskleration

when doing a direct comparison among recommendations and standards.

Alkunes-Tbe NIOSH recommendation, unlike OSHA’S or ACGIH’S, have a protective

Iwel for mixtures of alkanea: “noetnployee shall bexpoaed to individual Wakattes

or mixtures of these alkanes at ceiling concentrations greater than l,WO rng/ml ● s

determined over a sampling time of 15 minutes.”

Un&r OSHA standards, the following subatanw have only ceiling PEls. Exposure

to these chemicals “shall at no time exceed the ceiling vafue given fo~ that materials, ”

The chemicals regulated in this way are boron hifhsori&, chlorine, chloroform,

methylenebiphenyl isocyanate (MDI), toluene-2,4-diisocy anate, allyglycidyl ● ther

(AGE), diglycidyl ● ther (EXE), methyl hydruine, nitroglycerin, ethylene glycol

dinitrate, nitrogen dioxide, ● thyl mercaptan, methyl mercaptan, and vanadium (dust

and fume).

16. Long maximum exposwe-lhe NIOSH recommendation for benmw and carbon tetrachloride lists the maximum time Iimtt for exposure to conmntrationa at or above the

ceiling limit as 60 minutes (not the usual 15 minutes). Other maximum time limits

for exposure to conswntrations at or above the N1OSH ceiling limit are as follows:

beryUiurn (130 minutes), fo m’td&hy& (30 minutes), hydrazines (120 minutes), chloroform (60 minutes), dhxrmchloropropane (30 minutes), and nitroglycerin (Xl minutes),

17. Short Mu.mmum /Gposure-Un&r the NIOSH recommendation, tk maximum time

limit is 5 mmutes for worker exposure to concentrations of ammonia at or above the

acceptable ctiling limit, Other maxiumum time limitg for exposutw to concmrtrationa
380 . Preventing Illness and Injury In the Workplace

● ▼ or above & aclaptabk MosH dung limit am ae follow,: Cubon diaide (lo rnlnuta), cyanide (10 mfmltd,h- euifide (10 ndnuta), tofuene (10 minutes), xykne

(10 lnlnu=).

18. Carbon bkck-NIOSH be two recommended TWAe for cubon bkck. When Wbon Mie in the~ of pCdyC’ydiC h~N, the recommended TWA &

0.1 ~lm’. In dl @her~,the ~ TWA for carbon black k 3.5

mg/mJ and Me Ie the value Iietvd in the compdum tik.

19. hldhy&Iw ch/odde-Under the NIOSH rvcomrnertdation for methyfene chlorfde the

@UIng (m ppm) h to h Iouwed fn the Preaenm of cubon monoxkfe.

W Ketcmes-OSHA does not eet a smndard for Methyl kourtyl ketone.

21. Thiol and memptmt are 8yrtonyms. OSHA u8eJ the IUme merc+tan and he standards for ordy three of these compounds. NIOSH kbek them t!liOb utd recommend$

u~ for 16 thktk. fn addition, NfOSH mak ● note that ‘“mixtures of thiok

are to be controlled by Cdcukthll of qutvaknt cOrWmratioN.” The CompU’ilm

table Ay Contairu h TLVS for the kthAo18 tit- revered by afl thorganiMkru.

22. Vinyl hdides-in the summary of MOSH RecommendBtkm Vtnyl haude9 are

23.

Ckedfkd in one Catagory; the note under the expo$ure limit 9tate9 ““m promu@ed

for Vtnyl Chforide In 29 CPR 1910.1017 with eventual Sod of zero expoowe.’” h the

h“nt NIOSH/OSHA Currvnt lrIteflQmce ~ulletin 26 d Sept. 21,1978, the vinyl hdldeexpoeW8tMdud8 epecify vxpomwe limits for four vinyl ftdidm mononwre inaddition to vinyl chloride: vinyl bromide, Vinylidene dtloride, Vinyudene fluoride, and

vinyl fluodde. (Tfte9e Ue Usted in tk com@eon table.) The MCXH mommemktkn indudee the Su@dotl thu om@iond expomuv to vinyl brodde dvinyfidene

c#cgbrablr3uLWlX!dd010atom#e&*t uesupatcdcardWnm

ancn there are no ”etduds

for k four vinyf M*, either dr@y or u 8 ~.Wwever, the summary d

M02H rvcomrnenddcnu Iiets the OSHA 9mndard for vinyl hdidee u ● group ae

1 ppm TWA and S ppm dfIns p~iVQ kvef. Theee are the prokcttve kvek uoed

in the compar&orl table.

ACGIH doe, * bve ● recommended expouue fimit for vinyl halides ae ● group

but doee have mcommdatiotu for two member, of the group; vinyl brom* and

VInyfidetw chfodde. ~ ACGIH ~ for Vinyl brodde Cu14e8anufded

Warning that it be Wpected ~-for -. Cadmium-The OSHA @arIAI& eepsrste cadmium into dust 4fumes, & fiw

Wfemrlt PEbforeuh. ne8ummmry of Mo6H raunmMAtioem af90eepu8teIcad- mium into duu and fuma. However, ~~ mcomnwn&tioIu to ACGIH

TLVS b mum &ffkuh. ACGIH lists “cubnium,-md ufts, - Cd” and “c&$nium

Oxide, fume, as cd” and “pdwtion.” Cadmium oxide fume he ● c4ins limit of

O.@ ~lma under ACGIH. TIM mmpukon table uees the protecdvv kvek for cadmfum dust and safts for compmbn to both OSHA and NIOSH protective Ievefs.

24. Mwcury-MOSH snd OSHA have only one daseifkation for mercury, which is “in-

-.” ACGIH dividee mercury into three cstagorim, euh with dlffemnt TL.VS;

dkyl compodo, d forms excqt alkyl Vspor, Md al+ and inqanic compoW&

In the Cunpukon Me, the vxpoaum limit for Uyl and ine compounds i9 Wed

to canpuv with MOSH and OSHA protcck feds.

25. Nkkel–’The OSHA standu& label nickel ae “metal and solubk compotmtk, u Ni.’”

d N1OSH recommendations &cribee nkkef 8e “inor’gmic and cQmqvm 9epuue9 nickel into two ~,“trtetd” Md %Olubfe @mPOWUb#

ao Nf.” The latter Cbdfkation b d in the~tsbk

24. DDT-The MOSH ruummdation for DDT, as deuribd in the sumtnuy d rec-

~tkm,~w MI-: “Loweet reliably detectable fevd; 0.S ~/ml IWA

by MOSH Vdb&td method. * contact to be Wddd.”

27. The foUowfrtg eubotartca am fabdkd “’epecid Mad twkw” by N1OSH :

*/*l*f~*, chJ3Wne# DOT, ethyferte oxide, ethykrte

thioures, 4,4’-methykne-bb (240routllitw), d nfckel Cubonyl.

28. Nftdes-llte eummuy of MOSH mammen4tione ttotcs, ● t the bottom of the Ilet

of nitrue momawmhtkmm, that “Whal preunt ae rnIxtutw or with other oouKeo of

Cymnide, exp8ure to be mnddemd Xiditive and en virmmentd limit to be calculated.”

MOSH mcommdo TLVS for ten nitrlk compounds; TWA values for dx compmud

and cviling vdtee for three compounds. CEHA and ACGIH set TLW for onfy two

nitdfe compouA. The cornpubon table incfudes d * nltrik compound8 for Whidl

N1OSH eets cdhng TLVs.

29. FffmYtlsgks9-The OsHA Stan&d for fibrous gbiofietedin the,umrnuy of MOSH

mmmmmdations, but not in the OSHA ~.In the OSHA ~,fibrow

d- i8 daldfkd u “n~dwt” A ~by w~abh fraction. NIOSH

cbifks fibroue gfue as “totaf ffbrous glass.” ACGIH simply cksdfke it ae “ffbroue

gkee du9t.”

m. sflica-Smndar& and mmmmedatioln for dlica am Compfvx; U9udly Utfuzing fWlrulIU for difkrent pcrcatagee of sifica or quartz in mpirabk dust. The rnmsure is usually M/m’. In the comparison table, the “wont caee” $tandud or 100% eilica is Lued

a8 the Conpubon among the three ~tions. The NOSH recommendation for

dim is ● eingfe TLV. OSHA and ACGIH TLVS for dlica are calculated by ● fonmda,

and the9tar&rd chan@esaOmrd@ to the percent quutz in mspimbkdust. The 198344

ACGIH recommendstioru no lorqIw requhv that a formuk be used to meuure exIXWWV,~~ ACGIHhM eh@fied the table to chow numerical TLVs. In theowA

emnduds, dfica formuk for the MM* am covered in table z-3.

31. Tungsten-Them ● re no OSHA standorde for tungstm. MOSH divides tungsten into

four ca~ries. Both NIOSH and ACGIH hWC mcommmkthu for eolubk and ineolubk tungsten A thae are included in the compuieon table. NIOSH also rvcommenrb TLVS for %hwt of cemented hmgoten cubicle that b 2 perrsnt cobaft (0.1 mg/m~

TWA) and for “dust d canented ~carbide thm of 0.3 percmt nkkd (ls#lg

(nkkef)/ml TWA).

32. Vandhmr-nw OSHA CtMdud8 w~ VmdUm hto Vtillm Pentoxide dust

and fume (I/lo,), and fmwanadhm dust which is listed eepamtdy in theosHA table,

N102H mommede the eune standard for vanadium compounde (without further

-dt ~-v--- -urn carbide. -llw NfosH mmmmded

TLV for metallic vanadium is u9ed in the compubn tabk under ferrovarwdium.

ACGIH, Uke OSHA, dawlfiee vanadtum or vanadium pentoxkk ae respirable duet

and fume, and ferrovalwdium.

33. &ad-The OSHA St4n&rd for fead fue ● WA TLV. In addition, there is ● formula

to detmnhe the ‘1’LV for ~ over 8 hour, long. NIOSH he Onfy a recommended c+kng knit. ACGIH de,crtbee kuf exposuree ae hO~ fume and dust

and mmmmmds TWA and ceU@ TLVS.

34. Z,24”bromo-3-c)doropropsrw-The OSHA etandd for DBCP can be found in section 1910.1o44 of the OSHA etuKkd9. Eye contact and skin contact with DBCP are

prohibited and to be ● olded. fn addition, OSHA notes that it has k known to

cause stedlity in humuu and is ● potaltklcuuu risk. MOSH mcommed a C’dung

_vc til of O.1 W: $OptaXhUn of 30 tnhum. ACGIH dote not have

● mommeddetandud

3s. h theosHAstMduds the fouowtng”dwmkd $ are fhted indbting that ekin Cwltxt

b tO b WddNi: SCVhkk, ddfidtddlin, ChfOrOdi#Wlyt (both 42 PerCWIt and

~ l=-), dtl-Pr-# CYddet Dm, Lldtmethylhydruine, dinitroatho-crewl,

di oxuw, qkhkwohydh, hydradne, malathion, ftwthyl hydrdne, Ntbgltr

(both), Phd hydrubte, parathion, phenol, 1,1,2,2, -tetrddoroethme,

36. The foflowing PW of _can be found in the MOSH ~ of recommm-

&tionc, but they are not included in the compdmm table: decompdtion prO&##

of fluorocubn, Peeti4e rnanufmwfng d formulation, ultraviolet radiation, and

w-~X~ Y-m, ethykne thk$~, chry=ne, and benddene+ad

4=

37. In 1W3 OHSA held hearins on ● propoeed rwtdon to Its ethykne oxide standard,

At thoae hearings MOSH mmmmmdd tit (XHA should eet ● i%L. knver than 0.1

ppm ae an O-hour lWA and S ppm ss ● cdffng limit for ● period of 10 minutes. In

June 1904, OSHA bud ● find etandd of 1 ppm or 2 mg/m$ for an &hour TWA,

but did not issue wmil~ Iimft, That rvvieed recommendation and rwked etamkrcf

have not been Incorporated in the table or the comparbon.
Appendix B. —Working Papers

For this assessment, OTA commissioned a number of reports on various topics concerning occupational

health and safety. These contract reports, as well as two papers written by OTA staff, are being made available

through the National Technical Information Service as Working Papers.

The Working Papers have been grouped into three parts. Part A includes analyses of available data, historical discussions of several topics, descriptions and critiques of the techniques of economic analysis, and a

discussion of nonregulatory incentives. Part B covers descriptions of the personal protective equipment industry, theories of injury causation and control, information exchange, and worker training and education, Part

C consists of five Case Studies of different occupational hazards and diseases.

Working Papers

Part A:

#1—Kronebusch, K., Data on Occupationa/ Injuries

and Illnesses, working paper, December 1984.

#2—Mendeloff, J., An Analysis of OSHA Health Inspection Data, contract report, April 1983.

#3—Corn, J. C., Historical Perspective: The Evolution of the Definition of Certain Work-Related

Illnesses, contract report, July 1983.

#4—Kent, M., A History of Occupational Safety and

Health in the United States, contract report,

April 1983.

#5—MacLean, D., A History of the Consideration

of Economic Jmpacts in the Determination of the

Feasibility of Standards Under the OSH Act,

contract report, April 1983.

#6--Lave, J. R., and Lave, L. B., Decision Frameworks to Enhance Occupational Health and Safety Regulation, contract report, February 1983.

#7—MacLean, D., and Sagoff, M., A Critique of

Cost-Benefit Analysis as a Technique for Determining Health Standards Under the Occupational Safety and Health Act, contract report, April

1983.

#8—Harter, P. J,, Non-Regulatory Legal Incentives

for the Adoption of Occupational Safety and

Health Control Technologies, contract report,

April 1983.

Part B:

#9—Gough, M., The Personal Protective Equipment

and Clothing Industry, working paper, April

1984.

#10—Springborn Management Services, Inc., Report

on Workplace Protective Equipment and Clothing, contract report, August 1982.

#11—Purswell, J. L., and Stephens, R., Health and

Safety Control Technologies in the Workplace:

Accident Causation and Injury Control, contract

report, July 1983.

#12—Priest, W. C., Computer-Teleconferencing as a

Mechanism to Improve Information Transferor

Workplace Safety and Health, contract report,

May 1983.

#13—INFORM, Worker Training and Education Programs in Occupational Health and Safety, contract report, November 1983.

Part C:

#14—Arndt, R., and Chapman, L., Potential Office

Hazards and Controls, contract report, September 1984.

#15—Bleecker, M., Carpal Tunnel Syndrome: A Case

Study, contract report, May 1984.

#16—Goble, R., Hattis, D., Ballew, M., and Thurston, D., Implementation of the Occupational

Lead Exposure Standard, contract report, November 1983.

#17—Hickey, J. L. S., Rice, C. H., and Boehlecke, B.

A., Technologies for Controlling Worker Exposure to Silica, contract report, August 1983.

#18–Ruttenberg, R., Compliance With the OSHA

Cotton Dust Rule: The Role of Productivity Improving Technology, contract report, March

1983.

381
Appendix C.—Acknowledgments and

Health Program Advisory Committee

OTA would like to thank the members of the advisory panel who commented on drafts of this report and

the contractors who provided material for this assessment. In addition, OTA acknowledges the following individuals and groups for their assistance in reviewing drafts or furnishing information and materials:

Lori Abrams

Public Citizen

Theme Auchter

Occupational Safety and Health Administration

Peter Barth

University of Connecticut

Cynthia Bascetta

General Accounting Office

David Bell

Occupational Safety and Health Administration

Alfred Blackman

Potomac, MD

Leslie Boden

Harvard University

Mary Jane Belle

Congressional Research Service

Nancy Bollinger

National Institute for Occupational Safety

and Health

Queta Bond

National Research Council

Patricia Breslin

Occupational Safety and Health Administration

Thomas Brown

Department of Labor

Sandra Christensen

Congressional Budget Office

Patrick Coleman

National Institute for Occupational Safety

and Health

Geraldine Cox

Chemical Manufacturers Association

Thomas Crane

Office of Representative Barney Frank

Raymond Donnelly

Occupational Safety

Joseph DuBois

Occupational Safety

and Health Administration

and Health Administration

E. I. du Pont de Nemours & Co.

Wilmington, DE

Joseph Durst

United Brotherhood of Carpenters and

Joiners of America

Paul Dwyer

House Committee on Education and Labor

James Foster

Occupational Safety and Health Administration

Frank Frodyma

Occupational Safety and Health Administration

Sara Garrison-Leo

E. I. du Pent de Nemours & Co.

Anthony Goldin

Occupational Safety and Health Administration

Morris Gordy

Liberty Mutual Insurance Co.

Bengt Gustafsson

Swedish Embassy

Walter Haag

National Institute for Occupational Safety

and Health

Daniel Ham

Occupational Safety and Health Administration

Carmen Harleston

Occupational Safety and Health Administration

Daniel Hoeschen

Occupational Safety and Health Administration

Thomas Holzman

Department of Labor, Office of the Soliciter

John Inzana

Bureau of Labor Statistics

Daniel Jacoby

Department of Labor, Office of the Soliciter

William Johnson

Syracuse University

John Katalinas

Occupational Safety and Health Administration
App. C—Acknowledgments and Health Program Advisory Committee 383

Ruth Knight

Occupational Safety and Health

Akio Konoshima

Occupational Safety and Health

David LeGrande

Administration

Administration

Communication Workers of America

J. William Lloyd

Occupational Safety and Health Administration

Jeremiah Lynch

Exxon Chemical Co.

Mark MacCarthy

House Committee on Energy and Commerce

Judson MacLaury

Department of Labor, Historical Office

L. M. Magner

E. I. du Pent de Nemours & Co.

Andre Maisonpierre

Alliance of American Insurers

J. A. Martin

United Technologies

J. Donald Millar

National Institute for Occupational Safety

and Health

Minnesota Mining &

St. Paul, MN

Benjamin Mintz

American University

Franklin Mirer

Manufacturing

United Automobile Workers

(3M)

National Institute for Occupational Safety

and Health

Atlanta, GA, Cincinnati, OH, and

Morgantown, WV

Occupational Safety and Health Administration

Washington, DC

John Page

E. I. du Pent de Nemours & Co.

Randy Rabinowitz

Zwerdling, Schlossberg, Leibig, & Kahn

Knut Ringen

National Cancer Institute

Anthony Robbins

House Committee on Energy and Commerce

Frank Rosenthal

The Johns Hopkins University

John Russell

Timonium, MD

Herbert Schaffer

Bureau of Labor Statistics

Lyle Schauer

Bureau of Labor Statistics

Scott Schneider

United Brotherhood of Carpenters and

Joiners of America

Jack Snyder

Merck & Co.

Kate Sommers

National Research Council

Dorothy Strunk

House Committee on Education and Labor

John Tritsch

American Textile Manufacturers Institute

Ralph Vernon

Texas A&M University

Frank Wilcher

Safety Equipment Institute

Donald P. Wilmes

Minnesota Mining & Manufacturing (3M)

Sidney Wolfe

Public Citizen
384 ● Preventing Illness and Injury In the Workplace

HEALTH PROGRAM ADVISORY COMMITTEE

Sidney S. Lee, Committee Chair

President, Milbank Memorial Fund

New York, NY

Stuart H. Altman*

Dean

Florence Heller School

Brandeis University

Waltham, MA

H. David Banta

Deputy Director

Pan American Health Organization

Washington, DC

Carroll L. Estes**

Chair

Department of Social and Behavioral Sciences

School of Nursing

University of California, San Francisco

San Francisco, CA

Rashi Fein

Professor

Department of Social Medicine and Health Policy

Harvard Medical School

Boston, MA

Harvey V. Fineberg

Dean

School of Public Health

Harvard University

Boston, MA

Melvin A. Glasser***

Director

Health Security Action Council

Committee for National Health Insurance

Washington, DC

Patricia King

Professor

Georgetown Law Center

Washington, DC

Joyce C. Lashof

Dean

School of Public Health

University of California, Berkeley

Berkeley, CA

Alexander Leaf

Professor of Medicine

Harvard Medical School

Massachusetts General Hospital

Boston, MA

Margaret Mahoney*

President

The Commonwealth Fund

New York, NY

Frederick Mosteller

Professor and Chair

Department of Health Policy and Management

School of Public Health

Harvard University

Boston, MA

Norton Nelson

Professor

Department of Environmental Medicine

New York University Medical School

New York, NY

Robert Oseasohn

Associate Dean

University of Texas, San Antonio

San Antonio, TX

Nora Piore

Senior Advisor

The Commonwealth Fund

New York, NY

Mitchell Rabkin**

President

Beth Israel Hospital

Boston, MA

Dorothy P. Rice

Regents Lecturer

Department of Social and Behavioral Sciences

School of Nursing

University of California, San Francisco

San Francisco, CA

● Until April 19S3.

● *Until March 19S4.

● **Until October 19S3.

“Until August 19S3.

● *Until April 19S3.
App. C—Acknowledgments and Health Program Advisory Committee 385

Richard K. Riegelman

Associate Professor

George Washington University

School of Medicine

Washington, DC

Walter L. Robb

Vice President and General Manager

Medical Systems Operations

General Electric Co.

Milwaukee, WI

Frederick C. Robbins

President

Institute of Medicine

Washington, DC

Rosemary Stevens

Professor

Department of History and Sociology of Science

University of Pennsylvania

Philadelphia, PA
Appendix D.—Glossary of Acronyms and Terms

Glossary of Acronyms

AAIH —American Academy of Industrial

Hygiene

ABET —American Board of Engineering and

Technology

ABIH —American Board of Industrial Hygiene

ACGIH —American Conference of Governmental

Industrial Hygienists

AEPIC —Architectural and Engineering

Performance Impact Center

AIHA —American Industrial Hygiene

Association

ANSI —American National Standards Institute

AOMA —American Occupational Medical

Association

ASSE —American

ASTM —American

Materials

ATMI —American

Institute

AUPOHS —American

Society of Safety Engineers

Society for Testing and

Textile Manufacturers

University Programs for

Occupational Safety and-Health

BLS

CBO

CDC

CFR

COSH

CRS

CSHO

DHEW

DHHS

DOL

EPA

ERC

GAO

MSHA

NAS

NCHS

NCI

NFPA

NHIS

–Bureau of Labor Statistics (DOL)

–Congressional Budget Office (U.S.

Congress)

–Centers for Disease Control (PHS)

—Code of Federal Regulations

–Committee for Occupational Safety

and Health

–Congressional Research Service (U.S.

Congress)

—Compliance Safety and Health Officer

(OSHA)

–U.S. Department of Health,

Education, and Welfare

–U.S. Department of Health and

Human Services

—U.S. Department of Labor

—U.S. Environmental Protection Agency

—Educational Resource Center

–General Accounting Office (U.S.

Congress)

–Mine Safety and Health

Administration (DOL)

–National

—National

(DHHS)

—National

—National

—National

(NCHS)

Academy of Sciences

Center for Health Statistics

Cancer Institute (NIH)

Fire Protection Association

Health Interview Survey

NIEHS —National Institute of Environmental

Health Sciences

NIH –National Institutes of Health (DHHS)

NIOSH —National Institute for Occupational

Safety and Health (CDC)

NOES —National Occupational Exposure

Survey (NIOSH)

NOHS —National Occupational Hazard Survey

(NIOSH)

NRC –National Research Council (NAS)

NSC —National Safety Council

NSMS —National Safety Management Society

OMB —Office of Management and Budget

OSHA –Occupational Safety and Health

Administration (DOL)

OSH Act —Occupational Safety and Health Act

(Public Law 91-596)

OTA —Office of Technology Assessment

(U.S. Congress)

PEL –Permissible Exposure Limit (OSHA)

PHS –Public Health Service (DHHS)

SEER –Surveillance, Epidemiology, and End

Results program (NCI)

SIC —Standard Industrial Classification

TLV –Threshold Limit Value (ACGIH)

Glossary of Terms

Acute: Used to describe a disease or injury that is manifest soon after exposure to a hazard.

Add-on controls: Measures for injury and illness prevention which are put into place after the workplace

is built and equipment installed [see chs. 5, 6, and

16].

Administrative controls: Methods of reducing worker

exposures to occupational hazards through administrative arrangements. For example, rotating a

worker from areas of high exposure to areas of low

exposure reduces that worker’s average exposure

level. Also includes scheduling of jobs or processes

that generate hazards at times when few workers

are present. See engineering controls, personal protective equipment, and work practice controls [see

also chs. 5, 6, and 9].

Asbestosis: A restrictive chronic disease of the respiratory system resulting from exposure to asbestos

dust.

Asthma: Constriction of the bronchial tubes, in the

upper regions of the lung, in response to irritation,

allergy, or other stimuli.
App. D—Glossary of Acronyms and Terms ● 387

Bioassay: The use of animals to test chemicals or physical agents for harmful effects.

Bronchitis: Inflammation of the bronchial tubes in the

upper respiratory system.

Byssinosis: An obstructive chronic disease of the respiratory system resulting from exposure to cotton

dust [see ch. 5].

Cancer: The unrestrained growth of tissue.

Carcinogen: A substance or physical agent that causes

cancer.

Carpal Tunnel Syndrome: An affliction among workers doing hand work caused by compression of the

median nerve in the carpal tunnel, the passage in

the wrist through which blood vessels and nerves

pass to the hand from the forearm [see ch. 7].

Chronic: Used to describe a disease or injury that is

manifest long after exposure to a hazard. Also used

to describe persistent disease.

Collective bargaining: Negotiation between employers

and unions concerning wages, hours, and working

conditions [see ch. 15].

Complaint inspections: OSHA inspections that respond to worker or union complaints about workplace hazards. See fatality/catastrophe, follow-up,

and programmed inspections [see also ch. 12].

Compliance Safety and Health Officer (CSHO): The

formal title for OSHA inspectors.

Consultation: As used in this assessment, an OSHAfunded program that provides employers with a

confidential evaluation of the health and safety

hazards in their workplaces and recommendations

concerning hazard abatement [see ch. 12].

Contaminant: An undesirable chemical constituent of

a system or environment.

Control Technology Assessments: The name given to

a series of National Institute for Occupational Safety and Health reports assessing measures for preventing work-related injury and illness.

Cost-benefit analysis: An analytical technique that

compares the costs of a project or technological application to the resultant benefits, with both costs

and benefits expressed by the same measure. This

measure is nearly always monetary [see ch. 14].

Cost-effectiveness analysis: An analytical technique

that compares the costs of a project or of alternative projects to the resultant benefits, with costs and

benefits/effectiveness expressed by different measures. Costs are usually expressed in dollars, but benefits/effectiveness are ordinarily expressed in terms

such as “lives saved,“ “disability avoided,” “quality-adjusted life years saved, ” or any other relevant

objectives [see ch. 14].

Criteria Document: A series of National Institute for

Occupational Safety and Health reports which assess available literature to develop the background

necessary for standards. Upon completion these

documents are transmitted to the Occupational

Safety and Health Administration as recommended

standards [see ch. 12].

Dermatitis: Inflammation or irritation of the skin.

Dibromochloropropane (DBCP): A chemical used as

a pesticide. In the mid-1970s, a group of male workers discovered that their exposure to DBCP had rendered them sterile. An OSHA regulation limiting

exposures to DBCP was issued in 1978.

Dose: The amount of energy or substance absorbed

in a unit volume or an organ or individual. Dose

rate is the dose delivered per unit of time.

Educational Resource Centers (ERC): Fifteen academic centers established by the National Institute for

Occupational Safety and Health to provide multidisciplinary training for industrial hygienists, safety

specialists, occupational health nurses, and physicians. These centers also provide continuing education and technical assistance for their regions.

Emergency Temporary Standard (ETS): A standard issued under section 6(c) of the Occupational Safety

and Health Act. Such a standard may be issued

when OSHA determines that workers are exposed

to a “grave danger” from an occupational hazard

and that an emergency standard is necessary to protect them from that danger.

Emphysema: A condition of the lungs characterized

by an increase beyond the normal in the size of air

spaces in the furtherest reaches of the lung either

from dialation of the alveolii (the tiny sacs in the

the lung where oxygen from the air and waste carbon dioxide in the blood are exchanged) or from

the destruction of their walls.

Engineering controls: Methods of controlling worker

exposure by modifying the source or reducing the

amount of contaminants released into the workplace. Engineering controls include process design

and modification, equipment design, enclosure and

isolation, and ventilation. See administrative controls, personal protective equipment, and work

practice controls [see also chs. 5, 6, and 9].

Epidemiology: The study of the distribution of diseases

and their precursors in human populations.

Ergonomics: The study of how humans and machines

interact. In the occupational setting, one goal of ergonomics is to design the workplace to match worker capabilities.

Ethylene dibromide (EDB): A chemical used as a

fumigant and as a gasoline additive. It causes cancer in mice.

Experience rating: A system for setting worker compensation insurance premiums that is based on the

employer’s record or experience concerning injuries

and illnesses.
388 ● Preventing Illness and Injury In the Workplace

Exposure: The length of time and dose of chemical or

physical agent to which a worker is subjected.

Fatality/catastrophe inspection: An OSHA inspection

to investigate occupational fatalities or incidents

that result in the hospitalization of five or more employees. See complaint, follow-up, and programmed inspections [see also ch. 12].

Follow-up inspection: An OSHA inspection conducted

to verify employer abatement of a violation uncovered in a previous OSHA inspection. See complaint,

fatality/catastrophe, and programed inspections

[see also ch. 12].

General Duty Clause: Section 5(a)(1) of the Occupational Safety and Health Act. This section provides

that “each employer shall furnish . . . employment

and a place of employment which are free from recognized hazards that are causing or are likely to

cause death or serious physical harm to his employees.” OSHA has used this clause for workplace conditions that present serious occupational hazards

that are not covered by OSHA’s more detailed

health and safety standards.

Health and Safety Committees: Groups made up of

both management and labor within a plant that

meet to discuss and take mutual action to resolve

health and safety problems.

Health Hazard Evaluation (HHE): A hazard identification service provided by NIOSH. After receiving a request from employees or an employer, a

team of NIOSH researchers evaluate a workplace

to determine the toxicity of substances or processes.

Hierarchy of controls: The preference for using engineering controls to reduce or eliminate hazards.

This preference, long a tenet of professional health

and safety practice, has been followed by OSHA.

For example, to reduce exposures to air contaminants, OSHA requires that employers use engineering controls except when those controls are not feasible, not capable of reducing exposures to the

required levels, or while they are being designed and

installed.

Labeling standard: OSHA’s Hazard Communication

standard which requires that certain information be

provided to workers about the identity of workplace chemicals and their hazards [see ch. 15].

Loss-control service: Service provided by insurers to

client companies. Loss-control specialists visit worksites and offer advice on the prevention of property loss and work-related injuries and illnesses [see

ch. 15].

Lost-workday case: As defined by OSHA and BLS,

a work-related injury or illness that results in an employee missing time from work or that restricts the

employee’s work activity [see ch. 2].

Medical Removal Protection (MRP): A program specified by the OSHA lead standard. It requires removal of workers from lead-contaminated environments

when their blood lead levels exceed specified levels

[see ch. 5].

Medical treatment case: As defined by OSHA and

BLS, a work-related injury or illness that requires

medical treatment beyond first aid [see ch. 2].

Merit rating: See experience rating.

Mesothelioma: A malignant tumor of the membrane

that lines the internal organs of the body.

Monomer: A chemical substance that can undergo polymerization. See polymer.

Mutagen: A substance that causes mutations—changes

in the genetic material of. cells.

New Directions Program: An OSHA program to provide grants to employee, employer, educations, and

nonprofit organizations for the purpose of providing workplace health and safety training, educational materials, and services.

Permissible Exposure Limit (PEL): The maximum airborne concentration of a toxic substance permitted

by OSHA standards [see ch. 13].

Personal protective equipment: Equipment and clothing designed to control hazards. It includes hard

hats, safety shoes, protective eyewear, protective

clothing and gloves, hearing protectors, and various types of respirators, such as dust and gas masks.

See administrative, engineering, and work practice

controls [see also ch. 8].

Polymer: A chemical substance formed by the joining together of many simple molecules or monomers. For instance, many vinyl chloride monomers

are chemically joined to form polyvinyl chloride

(PVC). See monomer.

Positive pressure mask: Respirators in which air pressure inside the facepiece exceeds the outside air

pressure.

Programed inspection: Programed or general schedule

inspections are those OSHA inspections that are

scheduled using the injury experience or compliance

history of an industry. See also complaint, fatality/catastrophe, and follow-up inspections [see

ch. 12].

Protection factor: The ratio of measured concentrations of an airborne contaminant inside and outside the facepiece of a respirator, A measure of the

effectiveness of the respirator.

“Records review” inspections: After arriving at a workplace, an OSHA inspector examines the employer’s

injury and employment records. The inspector calculates the lost-workday injury rate for the employer. If that rate is below the national average for

manufacturing, the inspection will usually be ter-
App. D—Glossary of Acronyms and Terms ● 389

—

minated. For this assessment, these inspections have

been termed “records review” inspections. Currently, this policy applies only to programed safety inspections [see ch. 12].

Repetitive motion disorders: Diseases caused by

repetitive movement of part of the body. See Carpal Tunnel Syndrome.

Retro-fit controls: See add-on controls,

Right-to-know laws: State and local laws requiring

companies to identify the chemical names and hazards of their products to workers and the communit y.

Rulemaking: The administrative process by which

OSHA and other regulatory agencies set standards.

Silicosis: A restrictive chronic disease of the respiratory system resulting from exposure to airborne silica dust,

Standards issued after rulemaking: Health and safety

standards issued by OSHA using the procedures established by section 6(b) of the Occupational Safety

and Health Act. These procedures require that

OSHA provide notice of intended changes and an

opportunity for public comment.

Startup standards: The initial group of standards

adopted by OSHA under section 6(a) of the Occupational Safety and Health Act. These consisted of

established Federal standards and consensus

standards.

State Program: Under section 18 of the Occupational

Safety and Health Act, States may set and enforce

workplace health and safety standards. In this

assessment, these programs are termed “State Programs” [see ch. 12].

Teratogen: A chemical or physical agent that causes

physical defects in offspring.

Threshold Limit Value (TLV): Maximum airborne concentrations of toxic substances set as guidelines by

the American Conference of Governmental Industrial Hygienist [see ch. 13].

Tort liability: A legal basis for compensation when

property has been damaged or a person has been

injured. For occupational injuries and illnesses, most

lawsuits between employees and employers are

barred by State workers’ compensation laws, although suits against “third parties, ” such as manufacturers of machinery or producers of asbestos

products, are generally permitted [see ch. 15].

Toxicology: As used in this report, the testing of substances for toxic effects in animals.

Vinyl chloride monomer (VCM): The basic building

block chemical for polyvinyl chloride plastic. See

monomer.

Voluntary Protection Programs: OSHA programs designed to recognize the achievements of employers

and to provide additional opportunities for OSHAemployer consultation and cooperation. The three

programs are called “Star,” “Try,” and “Praise.”

Voluntary standards: Protective limits developed by

companies, trade associations, and professional organizations, but which do not have the force of law.

Walsh-Healey Public Contracts Act: This Federal law,

enacted in 1936, directed the Department of Labor

to issue requirements for safe work by Federal Government contractors and to “blacklist” contractors

who did not comply with these requirements.

Work practice controls: Methods of controlling hazards that involve only changes in job procedures

and housekeeping. See administrative controls, engineering controls, and personal protective equipment [see also chs. 5, 6, and 9].

Worker’s compensation: State-required insurance programs which pay for medical costs and replace a

portion of employees’ wages lost due to work-related injury and illness.
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Office, Dec. 31, 1975).

U.S. Congress, General Accounting Office, Federal Efforts to Protect the Public From Cancer-
412 . Preventing Illness and Injury in the Workplace

499.

500.

501

502,

503.

504.

505.

506.

507.

508.

509.

Causing Chemicals Are Not Very Effective,

MWD-76-59 (Washington, DC: U.S. Government Printing Office, June 16, 1976).

U.S. Congress, General Accounting Office, Z3etter Data orI Severity and Causes of Worker

Safety and Health Problems Should be Obtained

From Workplaces, HRD-76-118 (Washington,

DC: U.S. Government Printing Office, Aug. 12,

1976).

U.S. Congress, General Accounting Office,

States’ Protection of Workers Needs Improvement, HRD-76-161 (Washington, DC: U.S.

Government Printing Office, Sept. 9, 1976).

U.S. Congress, General Accounting Office, Delays in Setting Workplace Standards for Cancer Causing and Other Dangerous Substances,

HRD-77-71 (Washington, DC: U.S. Government Printing Office, May 10, 1977).

U.S. Congress, General Accounting Office, Sporadic Workplace Inspections for Lethal and

Other Serious Health Hazards, HRD-77-143

(Washington, DC: U.S. Government Printing

Office, Apr. 5, 1978).

U.S. Congress, General Accounting Office,

Health Hazard Evaluation Program Needs Improvement, HRD-78-13 (Washington, DC: U.S.

Government Printing Office, May 18, 1978).

U.S. Congress, General Accounting Office,

Workplace Inspection Program Weak in Detecting and Correcting Sen”ous Hazards, HRD-78-

34 (Washington, DC: U.S. Government Printing Office, May 19, 1978).

U.S. Congress, General Accounting Office, Labor Needs to Manage Its Workplace Consultation Program l?etter, HRD-78-15s (Washington,

DC: U.S. Government Printing Office, Dec. 18,

1978).

U.S. Congress, General Accounting Office,

Grain Dust Explosions-An Unsolved Problem,

HRD-79-1 (Washington, DC: U.S. Government

Printing Office, Mar. 21, 1979).

U.S. Congress, General Accounting Office,

How Effective are OSHA’S Complaint Procedures?, HRD-79-48 (Washington, DC: U.S.

Government Printing Office, Apr. 9, 1979).

U.S. Congress, General Accounting Office,

How Can Workplace Znjuries Be Prevented? The

Answers May be in OSHA FiZes, HRD-79-43

(Washington, DC: U.S. Government Printing

Office, May 3, 1979).

U.S. Congress, General Accounting Office, “Review of Small Business Administration’s occupational safety and health loan program, ” HRD79-82, letter to Ray Marshall and A. Vernon

Weaver from Gregory J. Ahart, June 6, 1979.

510.

511

512.

513.

514.

515.

516

517

517a.

518.

U.S. Congress, General Accounting Office, improved Quality, Adequate Resources, and Consistent Oversight Needed lf Regulatory Analysis Is To Help Control Costs of Regulations,

PAD-83-6 (Washington, DC, Nov. 2, 1982).

U.S. Congress, General Accounting Office, Znformal Settlement of OSHA Citations: Comments on the Legal Basis and Other Selected

Issues, HRD-85-11 (Washington, DC: October

26, 1984).

U.S. Congress, House Committee on Banking,

Finance, and Urban Affairs, Subcommittee on

Economic Stabilization, Catalog of Federal Loan

Guarantee Programs, Committee Print 97-10

(Washington, DC: U.S. Government Printing

Office, January 1982).

U.S. Congress, House Committee on Banking,

Finance, and Urban Affairs, Subcommittee on

Economic Stabilization, Industrial Policy, Hearings, 1983-84, Parts 1-6 (Washington, DC: U.S.

Government Printing office, 1983, 1984).

U.S. Congress, House Committee on Banking,

Finance, and Urban Affairs, Subcommittee on

Economic Stabilization, An Industrial Policy for

America: Is It Needed?, Committee Print 98-2

(Washington, DC: U.S. Government Printing

Office, April 1983).

U.S. Congress, House Committee on Banking,

Finance, and Urban Affairs, Subcommittee on

General Oversight and Renegotiation, Hearing

on Establishment of a National Development

Bank and Related Matters, Sept. 15, 28, 1982,

Serial No. 97-89 (Washington, DC: U.S. Government Printing Office, 1982).

U.S. Congress, House Committee on Education

and Labor, Report No, 91-1291, July 9, 1970

(Washington, DC: U.S. Government Printing

Office, 1970).

U.S. Congress, House Committee on Education

and Labor, Subcommittee on Labor Standards,

Occupational Health Hazards Compensation

Act of 1982, Hearings, Mar. 4, Apr. 21-22, 1982

(Washington, DC: U.S. Government Printing

Office, 1983).

U.S. Congress, House Committee on Education

and Labor, Subcommittee on Health and Safety,

OSHA Oversight–Review of 116 llorrnant

Rulemaking Projects, Hearing, Oct. 4, 1983

(Washington, DC: U.S. Government Printing

Office, 1984).

U.S. Congress, House Committee on Energy

and Commerce, Subcommittee on Oversight

and Investigations, Capital Formation and industrial Policy (Washington, DC: U.S. Government Printing Office, July 1981).
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behind Communicable Disease Surveillance,

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Wonder Tool or Mirage?, Committee Print No.

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Consumer Protection and Finance, Use of CostBenefit Analysis by Regulatory Agencies, Joint

Hearings, July 30, Oct. 10 and 24, 1979 (Washington, DC: U.S. Government Printing Office,

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29, July 13, 14, 27, and 29, 1983 (Washington,

DC: U.S. Government Printing Office, 1984).

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(Washington, DC: U.S. Government Printing

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U.S. Congress, Office of Technology Assessment, Assessment of Technolo~”es for Determining Cancer Risks From the Environment, OTAH-138 (Washington, DC: U.S. Government

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9758, Mar. 8, 1983.

U.S. Department of Labor, Occupational Safety

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48:26962, June 10, 1983.

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Index
Index

American Conference of Governmental Industrial

Hygienists, 9, 86, 206, 257-261

American Industrial Hygiene Association, 9

American National Standards Institute (ANSI), 9,

71, 206, 300

American Occupational Medical Association, 205

assessment of OSHA and NIOSH activities, 257

comparison of recommendations and standards,

257-262

impacts of NIOSH, 269

impacts of OSHA, 262

B. F. Goodrich, 81

Bureau of National Affairs, 314

Carter, President Jimmy, 280

Centers for Disease Control, 22o

Congress:

House Committee on Energy and Commerce, 4

Senate Committee on Labor and Human

Resources, 4

Council on Wage and Price Stability, 280, 282,

283

data on occupational injuries and illnesses, 29-38

occupational illnesses, 37

occupational injuries, 30

sources of information, 29

decisionmaking for occupational safety and health,

275-294

general issues, 275

OSHA decisionmaking on standards, 278

uses and limits of economic analysis, 289

Department of the Interior

Bureau of Mines, 145

Department of Labor

Bureau of Labor Statistics (BLS), 4, 5, 17, 29,

30, 36, 132, 167

Mine Safety and Health Administration, 219

dissemination of health and safety information, 11

Du Pent Co., 117, 155

economic incentives, reindustrialization, and

Federal assistance for occupational safety

and health, 327

economic incentives and financial assistance, 327

injury/exposure taxes, 327

tax programs and financial assistance, 329

Federal aid for research and information

dissemination, 338

reindustrialization and occupational safety and

health, 332

Educational Resource Centers (ERC), 10, 195

Environmental Protection Agency (EPA), 9, 63,

157, 280

ergonomics and human factors, 123

applying ergonomics to VDT design, 135

classification of ergonomics, 124

prevention of musculoskeletal injuries, 127

back disorders, 132-135

carpal tunnel syndrome (CTS), 127-132

Ford, President Gerald, 280

General Accounting Office, 220, 238, 287, 331

governmental activities concerning worker health

and safety, 219-254

current Federal/State framework, 219

assistant Secretaries and Directors, 221

Federal spending, 221

separation of research and regulation, 22o

National Institute for Occupational Safety and

Health, 242-253

development of controls, 247

dissemination, 249

identification, 243

priorities, 251

Occupational Health and Safety Administration,

224-242

enforcement, 232

public education and service, 237

standard-setting, 224

State programs, 239

health hazard identification, 41-64

occupational disease, 42

cancer, 45

musculoskeletal disorders,

necrologic disorders, 49

reproductive disorders, 48

respiratory disorders, 43

skin disorders, 49

known and unknown health

identified hazards, 52

45

hazards, 52

methods for detection of present, unidentified

hazards, 54

new hazards, 62

hierarchy of controls, 175-185

advantages and disadvantages of, 178

advantages of engineering controls, 179

problems with engineering controls, 181

problems with personal protective equipment,

179

description of, 175

423
424 . Preventing Illness and Injury in the Workplace

consensus standards, 176

controls for safety hazards, 177

Government standards, 177

views of health professionals, 175

OSHA’S policy, 182

actions by the current administration, 183

identification of occupational hazards, 6

incentives, imperatives, and the decision to

control, 297

assessment of existing incentives, 297

Government regulation, 320

labor market forces, collective bargaining, and

worker’s rights, 313

provision of information, 301

tort liability, 309

voluntary efforts, 297

workers’ compensation and insurance, 302

Internal Revenue Service (IRS), 16, 331

legislation:

Clean Air Act, 237

Coal Mine Health and Safety Act, 212, 219

Federal Mine Safety and Health Act of 1977,

145, 212

Flood Control Act of 1936, 277

Metal and Non-Metallic Mine Safety Act of

1966, 219

Mine Safety and Health Act of 1977, 219

Noise Control Act of 1972, 157

Occupational Safety and Health (OSH) Act, 4,

12, 23, 29, 36, 86, 145, 177, 195, 213, 219,

220, 224, 239, 242, 276, 278, 284, 314

Toxic Substances Control Act (TSCA), 58, 63,

64

Walsh-Healey Act, 86, 213

National Cancer Institute, 238

National Center for Health Statistics (NCHS), 5,

16, 30

National Death Index (NDI), 16, 58

National Electronic Injury Surveillance System

(NEISS), 32

National Highway Traffic Safety Administration,

73

National Institute for Occupational Safety and

Health (NIOSH), 6, 9, 11, 16, 18, 21, 22,

25, 30, 32, 38, 43, 55, 64, 73, 81, 83, 90,

104, 110, 134, 153, 158, 159, 161, 189, 197,

200, 219, 220, 242-253, 257-271, 359-380

National Library of Medicine, 11

National Occupational Exposure Survey, 97

National Safety Council (NSC), 4, 29, 69, 205, 298

North Carolina, 86

Occupational Safety and Health Administration

(OSHA), 6, 10, 11, 13, 14, 19, 20, 22, 23,

25, 29, 34, 35, 45, 86, 90, 92, 93, 104, 110,

145, 189, 197, 219, 220, 224-242, 257, 271,

275, 278-288, 298, 359-380

enforcement, 232

inspection and enforcement, 14

regulation, 13

standard-setting, 224, 281

occupationally associated deaths, injuries, and

illnesses, 4-6

Office of Management and Budget (OMB), 13,

280, 281, 287

options for controlling workplace hazards, 16-26

creation of Occupational Safety and Health

Fund, 24

data and hazard identification, 16

education, training, and information

dissemination, 19

improved control technologies, 18

incentives and imperatives, 21

needs of small businesses, 25

role of OSHA, 22

personal protective equipment, 143-172

hearing protectors, 154-158

acceptance of, 156

conservation programs, 155

field testing, 158

noise reduction ratings, 157

respirators, 143-154

deficiencies in programs, 152

dust masks, 148

field testing, 149

fit testing, 145

Los Alamos Scientific Laboratory studies, 147

NIOSH certification, 1s3

third-party testing, 1s4

personal protective equipment, other types of,

159

NIOSH tests, 159

protective eyewear, 163

tests of gloves against chemical hazards, 166

third-party laboratory testing, 170

preventing work-related injury and illness in the

future, 345

opportunities for prevention, 346

private and public activities, history of, 205

government efforts, 207

early Federal Government programs, 210

Federal legislation and regulatory programs,

212

Federal research and assistance in occupational

safety and health, 211
—

Index . 425

State health and safety programs, 209

workers’ compensation, 207

voluntary efforts, 205

American Conference of Governmental

Industrial Hygienists, 206

American National Standards Institute, 206

American Occupational Medical Association,

205

National Safety Council, 205

Public Health Service, 211

Reagan, President

reindustrializa tion

safety, 15

Safety Equipment

Ronald, 281

and workplace health and

Institute, 154

safety haza;d identification, 67-74

injury causation, 69-74

supplemental information on OSHA and NIOSH,

359-380

technologies for controlling work-re

77-99

control systems, 78-85

control at the source, 80

ated illness,

control at the worker, 85

controlling dispersion, 82

control technology usage in the United States,

97

controlling worker exposure to cotton dust,

85-89

controlling worker exposure to lead, 92

controlling worker exposure to silica dust, 89

technologies for controlling work-related injury,

103-119

Du Pent injury control program, 117

fire and explosion prevention, 113

injury control programs in industry, 116

preventing construction-related injuries, 106

preventing manufacturing-related injuries, 108

preventing motor vehicle-related injuries and

fatalities, 106

technologies to control hazards, 7

training and education, 10, 189-202

computer networks, 200

engineers and managers, 199

occupational safety and health professionals, 195

worker training and education, 189

U.S. Supreme Court, 86, 284