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Occupational Safety and Health PH 150 10/19/09. Population Health Focuses on improving health of communities – saves lives millions at a time, not just.

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Presentation on theme: "Occupational Safety and Health PH 150 10/19/09. Population Health Focuses on improving health of communities – saves lives millions at a time, not just."— Presentation transcript:

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 20 th Century Advancements In the 20 th 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 Health care 97% Population Health 3% The 97/3 Problem

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

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 Fatal6,529 n Non-fatal*13.25 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 Youre 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 IncomeHigh IncomeTotal All Causes48.47.956.3 Communicable Diseases 17.6.5618.2 Non-communicable Diseases 26.06.932.9 Injuries4.7.475.2

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 59% France and Germany 57% Switzerland 53% Netherlands 38% Italy 37% Spain 26% Source ILO, 1995

19 Women Participating in the Global Workforce Developing Countries% of women who work* China80% Mozambique 78% Vietnam 77% Thailand 67% Brazil and Chile 33% Mexico /Argentina32% Egypt, Saudi Arabia, Oman, and Jordan 10% Algeria 8% * Includes the informal workforce Source, ILO, 1995


21 Aging Workforce Source Health Affairs, May/June 2000

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

23 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 Dont 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 Dont Get What You Pay For, cont. WHO ranked 191 countries U.S. 37 th in overall performance U.S. 24 th in overall health attainment U.S. among its peers Of 29 countries in OECDOrganization for Economic Cooperation and Development Ranked 23 rd in infant mortality Ranked 21 st 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, 1980 - 2000 0 2 4 6 8 10 12 14 16 18 20 198019811982198319841985198619871988198919901991199219931994199519961997199819992000 Year Injury rate per 100 full-time workers Agricultural production Construction Nursing and personal care

37 Health Care Industry Health care workers = 8% of U.S. workforce 1996-2006: 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 Overall: of all Hep B&C, ~40% due to sharps Of all HIV, about 1 – 12% due to sharps 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Percentage Attributable fraction of Hep C, Hep B and HIV infections in healthcare workers due to injuries with contaminated sharps, ages 20-65 HCV HBV HIV Africa Americas E Med. Europe SE Asia W Pacific

41 Occupations of Victims of Nonfatal Workplace Violence 1992-96 # per 1,000 OccupationAnnual Average Workers Total2,009,40014.8 Medical Physicians10,00015.7 Nurses69,50024.8 Technicians24,50021.4 Other56,80010.7 Mental Health Professional50,30079.5 Custodial8,70063.3 Other43,50064.0 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 = 8 th 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 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 Hospital Nurse Staffing and Patient Mortality, Nurse Buyout and Job Dissatisfaction 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 Design: Linked data from discharge of 168 adult hospitals in PA, 10,000 nurses (random survey), 230,000 patients Results: Source: Aiken et al. JAMA 2002; 288:1987-93

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 1992-2008

50 Worker productivity (2000-2007) 20% Real income working, middle-class households ( $2,000) 3%

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

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