1. Occupational
Safety and Health
PH 150
10/19/09

2. Population Health
Focuses on improving health of communities – saves lives millions at a time, not just one at a time
Prevents disease and disability
Promotes healthy environments and behaviors
Assures high quality, cost-effective health care

3. Linkages and Overlaps Public/Health Care Systems Population Health
Personal
Health

4. 20th Century Advancements
In the 20th Century public health worked hand in hand with medical advances to:
Decrease infant mortality by 99%
Reduce the incidence of coronary disease by 51%
Eradicate many crippling and deadly infectious diseases
Add 25 years to our lifespan

5. Investments Not Effectively Targeted
The 97/3 Problem
Population Health 3%
Health care
97%

6. Investments Not Effectively Targeted
Value of Investment
Population Health
Individual Healthcare
Preventing obesity in the U.S. will save $147 billion per year
(CDC, July 2009)

7. Investments Not Effectively Targeted
90/10 problem
Only 10% research funds allocated to problems of most concern to 90% of world population

8. An Ecological Model of Health
Population health modeled on evidence that there are multiple determinants of health
Education
Socioeconomic Status
Employment
Housing
Medical care
Behavior
Biology (genetics)
Physical environment
Social environment

9. Magnitude of the Problem
10 million work-related injuries/year
430,000 new work-related diseases/year
Each day:
9,000 sustain disabling injuries
16 die from injury
137 die from work-related disease

10. Annual Toll of Occupational Injury and Illness
Injuries
n Fatal 6,529
n Non-fatal* million
n Total costs $145 billion
Diseases
n Fatal** 60,300
n Non-fatal 862,200
n Total costs $26 billion
* 46% disabling (6.09 million)
** Based on cancer, cardiovascular disease, chronic respiratory disease, neurologic and renal disorders

11. Annual Economic Burden of Disease and Injury
1997; Leigh et al. Arch Int Med.

12. Advancing Population Health: A Global Perspective
Globalization Transforming Health Sector
Global health is the health of populations in a global context and transcends the perspectives and concerns of individual nations* (includes international and domestic health)
Global Health is Public Health
You’re only as Healthy as the World you Live in
*World Health Organization and the Transition from “International to Global” Public Health. Brown et. al. AJPH, 2006)

13. Global Burden of Occupational Injury and Illness
Among 2.7 billion workers
Each year:
2 million deaths from disease and injury
270 million workers sustain non-fatal injuries
12 million injuries among youth workers (12,000 fatal)
4% gross domestic product (GDP) lost per year

14. Annual Global Mortality In Millions
Low Income
High Income
Total
All Causes
48.4
7.9
56.3
Communicable Diseases
17.6
.56
18.2
Non-communicable Diseases
26.0
6.9
32.9
Injuries
4.7
.47
5.2

15. Occupational Risk Hazards

16. THE US WORKFORCE Size of workforce: 139 million Unionized: 12%
Unemployed: 9.8%
Changing Demographics
*As of September, 2009

17. Projected Changes in Civilian
Labor Force 2006 to 2016

18. Women Participating in the Global Workforce
Developed Countries % participation rate
Sweden and Denmark 75%
United States %
France and Germany 57%
Switzerland %
Netherlands %
Italy %
Spain %
Source ILO, 1995

19. Women Participating in the Global Workforce
Developing Countries % of women who work*
China 80%
Mozambique 78%
Vietnam 77%
Thailand 67%
Brazil and Chile 33%
Mexico /Argentina 32%
Egypt, Saudi Arabia,
Oman, and Jordan 10%
Algeria %
* Includes the informal workforce
Source, ILO, 1995

21. Source Health Affairs, May/June 2000
Aging Workforce
Source Health Affairs, May/June 2000

22. Projected Changes in Employment by Industry
Source: BLS, Franklin 2007

23. Source: Bureau of Labor Statistics
Growth of the Contingent Workforce
Source: Bureau of Labor Statistics

24. Informal Sector Majority of new jobs in developing countries
Subcontracting
Independent, cater to markets at low end of income scale
Household-based
Unpaid female labor, family members
Independent service sub-sector
Bulk of informal sector, lowest skills
Maids, street vendors, cleaners, casual unskilled laborers
ILO 1999

25. Informal Workforce (% of Total Urban Employment)
Africa – 60%
Bolivia and Madagascar– 57%
Tanzania – 56%
Colombia – 53%
Thailand – 48%
Venezuela – 46%
Industrialized Countries – 5-10%
ILO 1999/WHO 1995

26. Annual Hours Worked
Source: OECD 2003

27. Changing Nature of Work: Increased Stress
Three-fourths of employees believe the worker has more on-the-job stress than a generation ago

28. Work Organization/Stress - Severity of the Problem
No good surveillance systems and few studies in the U.S.
Estimated 13% of U.S. worker compensation claims are for stress-related disorders
27% of U.S. workers reported jobs are greatest single source of stress
60% sampled women workers cited job stress as biggest problem at work

29. Employment Trades Index (ETI) and Labor-Market Indicators
Percentage saying “jobs hard to get”
Initial claims for unemployment insurance
Percentage of firms with one or more jobs open
Number of employees hired by temporary-help industry
Part-time workers for economic reasons
Job openings
Industrial production
Real manufacturing and trade sales

31. U.S. Health System: You Don’t Get What You Pay For
Highly fragmented at all levels
Most expensive (16.3% of gross domestic product)
One of least accessible (48 million uninsured, more underinsured)
U.S. pays for half of all personal health care (e.g. Medicare/Medicaid, DOD, VA, federal worker insurance)

32. U.S. Health System: You Don’t Get What You Pay For, con’t.
WHO ranked 191 countries
U.S. 37th in overall performance
U.S. 24th in overall health attainment
U.S. among its peers
Of 29 countries in OECD—Organization for Economic Cooperation and Development
Ranked 23rd in infant mortality
Ranked 21st in male life expectancy
Met only 15% of Healthy People 2000 objectives (deteriorated in 20% of objectives)

33. Does Being Uninsured Matter?
YES
20% uninsured (vs. 3% insured) did not get medical care for a serious medical problem
30% uninsured (vs. 12%) did not fill a prescription
39% uninsured (vs. 13%) skipped a recommended test or treatment
13% (vs. 4%) had trouble getting mental health care

34. Employer-Sponsored Health Insurance
Source: Kaiser Family Foundation

35. Insurance for Work-Related Conditions
Workers’ compensation no fault, state by state
Illnesses > injuries often contested
Worker may be uninsured or underinsured for set of conditions despite being deemed fully insured

36. Occupational Injuries in U.S.
Incidence rates of nonfatal occupational injuries (total recordable cases) by
selected industry sectors, 20 18 16 14 12
Injury rate per 100 full-time workers 10 8 6
Agricultural production
Construction
Nursing and personal care 4 2
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
Year

37. Health Care Industry Health care workers = 8% of U.S. workforce
: 2 of the 4 fastest growing industries are HC-related (health services and health practitioners’ offices)
Health care services are growing at twice the rate of the overall economy

38. Health Care Worker Hazards
Biological hazards
bacteria, viruses, fungi, parasites
Chemical hazards
medications, solutions, gases
Physical hazards
radiation, electricity, extreme temperatures, noise, lifting
Psychosocial hazards
factors causing stress, emotional strain, interpersonal problems

39. Needlestick Injuries
Exposure to bloodborne pathogens (HIV, Hepatitis B, and Hepatitis C)
In the United States, approximately 800,000 needlestick injuries occur in hospitals annually -- an average of one injury every 10 seconds
1/3 of all sharps injuries have been reported to occur during disposal activities

40. Infections in Health Care Workers (35 million worldwide)
Attributable fraction of Hep C, Hep B and HIV infections in health care workers due to injuries with sharps, ages 20-65
Attributable fraction of Hep C, Hep B and HIV infections in healthcare
workers due to injuries with contaminated sharps, ages 20-65
100%
HCV
90%
HBV
80%
HIV
70%
60%
50%
Percentage
40%
30%
20%
10% 0%
Africa Americas E Med. Europe SE Asia W Pacific
Overall: of all Hep B&C, ~40% due to sharps Of all HIV, about 1 – 12% due to sharps

41. Occupations of Victims of Nonfatal Workplace Violence 1992-96
# per 1,000
Occupation Annual Average Workers
Total 2,009,
Medical
Physicians 10,
Nurses 69,
Technicians 24,
Other 56,
Mental Health
Professional 50,
Custodial 8,
Other 43,
Source: Bureau of Justice Statistics, 1998

42. BLS Data on Nonfatal Workplace Assaults, by Source of Injury (1995)
Health Care
Patient, 51%
Other
Source,
12%
Other Person,
29%
Worker/
Former
Coworker, 8%

43. Work Organization Stressors in Health Care Settings
Death and dying
Floating
Work overload
Work environment
Family stress
Role conflict
Shiftwork

44. Effects of Medical Error
IOM estimates that medical errors cause 44,000-98,000 deaths annually
Medical error = 8th leading cause of U.S. deaths
Medical error causes more deaths than auto accidents, breast cancer and AIDS
Chicago Tribune: “To compensate for understaffing, hospitals often rely on machines with warning alarms to help monitor patients’ vital signs. At least 216 patient deaths and 429 injuries have occurred in hospitals where registered nurses failed to hear alarms built into lifesaving equipment, such as respirators and blood-oxygen monitors.”

45. Urinary Tract Infection 9.0% Upper Gastrointestinal Bleeding 5.1%
More registered nurses are associated with shorter length of stay and fewer complications
Outcome
%Lower
Length of Stay
3.5%
Urinary Tract Infection
9.0%
Upper Gastrointestinal Bleeding
5.1%
Pneumonia
6.4%
Shock/Cardiac Arrest
9.4%
Failure to Rescue
3.9%
Source: Needleman et al., Nurse-Staffing Levels and Quality of Care in Hospitals, NEJM, 2002

46. 43% high emotional exhaustion 42% dissatisfaction with current job
Hospital Nurse Staffing and Patient Mortality, Nurse Buyout and Job Dissatisfaction
Design: Linked data from discharge of 168 adult hospitals in PA, 10,000 nurses (random survey), 230,000 patients
Results:
Nurses –
94% women
43% high emotional exhaustion
42% dissatisfaction with current job
After adjustment for patient and hospital characteristics, each additional patient per nurse →
23% ↑ burnout
15% ↑ job dissatisfaction
7% ↑ patient mortality
Source: Aiken et al. JAMA 2002; 288:

47. Fewer People, Same Work Work organization factors
Downsizing
Deskilling and collapsing of job titles
More patients at higher acuity levels
Decline of non-profit facilities
Fewer people + same work added stress and fatigue compromised patient care

48. Improving Worker Health and Safety Leads To:
Improved health status
Decreased health care/related costs
Increased productivity
Increased quality

49. Job Creation

50. Worker productivity (2000-2007) 20%
Real income working, middle-class households ( $2,000) %

51. The Future: Job Creation – Infrastructure Support
Education
Health and Health Care
Energy/Transportation
Research