Counting work-related injuries, disease and death among US workers: Part 1

"Death takes no holidays in industry and commerce," is how Labor Secretary Willard Wirtz described the toll of on-the-job death and disability for U.S. workers. The Secretary's remarks in 1968 were part of congressional hearings on legislation that ultimately established the Occupational Safety and Health Administration (OSHA). He suggested that because most work-related fatalities and injuries happen one or two at a time, day in and day out, the carnage continues

"because people don't realize its magnitude, and can't see the blood on the things they buy, on the food they eat, and the services they get."

At the time, advocates of a strong federal worker safety law used the following figures to explain the scale of the problem: 15,000 fatal work-related injuries per year, along with another 7 million workers injured and 2 million disabled. Most recognized, however, the limitations in these estimates. A special report prepared in 1965 for the U.S. Surgeon General noted the absence of a comprehensive system for occupational injury and disease surveillance. The authors of "Protecting the Health of 80 Million Americans" wrote:

"it is almost inconceivable that this nation, with its vast resources and technical skills, has never developed a comprehensive picture of the work environment to determine the relationship with the health status of its productive work force."

Several provisions of the OSH Act of 1970 were designed to fill some of those data gaps---at least in industries covered by OSHA---but the U.S. is far from having a comprehensive occupational injury and illness surveillance system. Through a series of post here at The Pump Handle, you'll be introduced to our nation's current methods for counting work-related injuries, disease and death among U.S. workers, and their limitations. You'll be invited, as always, to share what you know about this topic and offer suggestions for other models, including those used abroad.

Surveillance: an integral part of public health practice

An ongoing, systematic collection and analysis of adverse health events is critical for sound public health policy making. We call it surveillance. There are several provisions in the OSH Act that reflect an appreciation by the bill's authors for the value of occupational injury and illness surveillance---for planning, data dissemination, program implementation and evaluation. Specifically:

â¢Section 8(c)(1): Requires employers to keep records and make them available to US Departments of Labor (DOL) and Health and Human Services (HHS) officials such as records that could be used "for developing information regarding the causes and prevention of occupational accidents and illnesses."

â¢Section 8(c)(2): Instructs DOL, in cooperation with HHS, to issue regulations for employers' periodic reporting of work-related injuries and illnesses.

â¢Section 20 and Section 22: creates the National Institute for Occupational Safety and Health (NIOSH) within HHS, and authorizes it "to establish such programs of medical examinations and tests as may be necessary for determining the incidence of occupational illnesses...," and "enter into contracts, agreements or other arrangements for the purpose of conducting studies relating to his responsibilities under this Act."

â¢Section 23: allows DOL to make grants to State agencies to establish "systems for the collection of information concerning the nature and frequency of occupational injuries and diseases."

â¢Section 24(a): instructs DOL, in consultation with HHS, to "develop and maintain an effective program of collection, compilation and analysis of occupational safety and health statistics." DOL "shall compile accurate statistics on work injuries and illnesses..."

Early in OSHA's history, the responsibility for collecting and analyzing occupational injury and illness statistics was delegated by the Secretary of Labor to DOL's Commissioner of Labor Statistics. It would be the Bureau of Labor Statistics' (BLS)) responsibility, not OSHA's, for collecting and tabulating work-related injury and fatality statistics. In a 1971 order, Labor Secretary J.D. Hodgson said BLS was responsible for:

"...developing and maintaining an effective program for collection, compilation, analysis and publication of occupational safety and health statistics, and
making grants to States or political subdivisions thereof in order to assist them in developing and administering programs dealing with occupational safety and health statistics."

BLS's statistical program on worker injuries and death has evolved over the last 40 years. Currently, the bureau provides two key annual reports to fulfill these responsibilities: the Census of Fatal Occupational Injuries (CFOI) issued in August and the Survey of Occupational Injuries and Illnesses (SOII) issued in October.

Annual Count of Fatal Work-Related Injuries (but not Illnesses)

BLS provides grants to state agencies to compile data from a variety of sources on every work-related fatal-injury case occurring in the U.S. in a given year. They rely on death certificates, news media accounts, police reports, workers compensation records, fatality reports submitted to OSHA, the Mine Safety and Health Administration (MSHA), the National Transportation Safety Board (NTSB) and other federal agencies, and motor vehicle reports. For each fatality case, they attempt to confirm the information and its work-relatedness using at least three data sources, and may assemble as many as 30 data elements for each event, such as age of the worker, occupation, industry, and nature of the injury.

The census includes cases of worker deaths from the private and public sector (e.g., prison guards, fire fighters) but does not include U.S. workers killed overseas (e.g., military or U.S. contractors). The decedent had to be engaged in legal work activities (e.g., the death of a sex worker would not be included), and it makes no difference whether the worker was earning an hourly wage or salary, or was self-employed.

BLS instituted this census methodology in 1992, after worker safety, public health and policymakers identified severe shortcomings in a survey method used previously by BLS. Many deficiencies in the survey method were outlined in a 1987 National Research Council report entitled "Counting injuries and illnesses in the workplace: proposals for a better system." The survey method was found to capture only about half the number of work-related fatal injuries. In 1990, the official count of work-related fatal injuries was 2,900, an estimated based on BLS's survey method. In 1992, the first year using the new census model, the count of fatal work injuries was 6,217.

The most recent CFOI was issued in August 2010. BLS provided a preliminary fatality count for 2009 of 4,340 fatal occupational injuries. The lowest count in the census' 17 year history. BLS' final tally of fatalities is typically issued in April of the following year, frequently with a revised figure showing a couple of hundred more fatalities.

Although many people refer to the CFOI data as a worker fatality count, it's wise to remember that the tally does not include fatalities caused by a work-related disease, such as asbestosis, hepatitis (e.g., in a health care worker) or certain cancers. BLS includes a small footnote on its lengthy data tables that says:

"CFOI does not count fatalities related to an occupational illness unless it was precipitated by an injury event,"

but this fact seems lost in many news accounts of the annual release of fatality data.

DOL and HHS's failure to account in some way for occupational disease mortality and morbidity in our nation's surveillance system is not a new problem. In 1984, the House Committee on Government Operations held a series of hearings on the Executive Branch's inability to address occupational illness surveillance.

"Since the passage of the OSH Act nearly 15 years ago, a bipartisan failure of four administrations has thwarted the mandated development of an information and data collection system on occupational diseases. No reliable national estimate exists today, with the exception of a limited number of substance-specific studies (such as on asbestos), on the level of occupational disease, cancer, disability, or deaths. It cannot be meaningfully determined if diseases from chronic exposure to hazardous substances represents a greater problem today than when the OSH Act was passed in 1970. Such lack of reliable accurate data greatly hampers any broad-based evaluation of the OSHA program."

The committee staff who authorized that indictment would find little has changed in this regard in the subsequent 25 years.

A surveillance system for occupational illnesses and deaths poses a number of challenges, including latency and multi-causality of diseases. These factors will be explored in the next installment in this series, along with estimates published by a number of colleagues on the magnitude of work-related disease and disability for US workers.

Read Part 2 and Part 3 of this series