In this module, I'm going to talk with you about occupational health, an incredibly important discipline within public health. You might ask, why is this so important? Well, unless you have a trust fund, once you finish this degree or perhaps already, you're going to be out in the workforce and you're going to have exposures in the occupational environment. Hopefully this lecture, maybe more than most, has a personal connection to you. Why should we care about occupational health beyond that personal connection? I want to compare and contrast occupational health to some other common public health maladies that we face in the United States. Let's talk about the number of people who die each year from some major sources of mortality in the US and also the estimated cost. Cardiovascular disease is the top killer of Americans. It kills about 635,000 people per year at a cost of almost half a trillion dollars per year. That's a huge public health problem. Cancer kills slightly fewer people, about 600,000 at a cost of about $219 billion. Stroke kills 142,000 Americans at a cost of about $63 billion per year. Finally, the lowly influenza virus kills over 50,000 Americans a year at a cost of $20 billion. Those are huge burdens we've dedicated a lot of resources to addressing them and had some success. On the flip side, if we look at occupational health, in the US in any given year, we kill somewhere between 4 and 6,000 workers directly on the job and another 50-60,000 workers will die of occupational-related illness at a cost of about $52 billion. In the workplace, we're killing more people than the flu kills at a cost approaching that of stroke. But unlike the flu and the stroke, we don't really have national coordinated efforts to address this problem. If we zoom out globally, almost three million people die each year as a result of occupational fatalities. That's about 7,500 people each and every day or about 5-7 percent of global deaths, of which the vast majority are from disease, but about 1,000 out of those 7,500 are from immediate acute fatal injuries. We've covered the exposure disease framework in several other modules. I'd like to return to it here just to refresh your mind and focus on the fact that in occupational health, all of these steps are occurring within the workplace. We've talked about other agencies that regulate environmental health generally. In the US, there's one agency that's specifically responsible for regulating occupational health and that's the Occupational Safety and Health Administration or OSHA. This agency was established by the Occupational Safety and Health Act in 1970 and given very broad powers to regulate workplace conditions. Unfortunately, a lot of the exposure limits that OSHA has for contaminants and hazards in the workplace were adopted from voluntary guidelines that existed all the way back in 1968, most of those have never been updated. OSHA does have something called the General Duty Clause, which basically says, ''Employers can't simply expose workers to unsafe conditions even if there's no specific standard or limit that applies to them.'' People often are unaware of OSHA's limitations though. OSHA has no jurisdiction over federal or state workers. OSHA is a very small agency, they have about one inspector for every 60,000 workers and they're responsible for covering and enforcing nine million workplaces. While some industries will say, "We're very concerned that OSHA could come inspect us at any time," statistically, the odds of a company getting inspected by OSHA are once every 57 years. If you as a worker are waiting for OSHA to come around and check out your workplace, I have a news break for you, it's not going to happen. I would like to give you some examples of standards that OSHA has passed and now requires employers to comply with. Employers have to provide fall protection, so workers aren't injured through falls. They have to prevent workers from being exposed to infectious disease. That they are safe when they enter what are called confined spaces. They have to ensure that workers aren't exposed to excessive amounts of chemicals. They have to put guards or enclosures around dangerous machines to make sure people can't come into contact with those machines. Employers have to provide respirators and other safety equipment that workers can wear to keep themselves safe. Employers have to provide health and safety training to workers and absolutely have to communicate information about workplace hazards to those workers. Occupational health has come a long way in this country. That's the good news. The image you're looking at here is a death calendar for industry in Allegheny County, Pennsylvania from July 1906 to June, 1907. Every red mark you see on that calendar is a worker who died. In this one-year period, 195 steelworkers died out of a total of 526 total work-related deaths in this one county over one year. Fast forward to 1997, only 17 steelworkers died in the entire United States, so that is a tremendous improvement. As with all types of environmental health issues, we've passed policies to improve occupational health, and that gives us an opportunity to evaluate those policies. One thing we could look at is injuries. Here we're looking at several different types of injuries that have occurred between 1976 and 2013. What you can see here is the vast majority of these lines for different severities of injuries decline over time, that's good. OSHA, remember, was established in 1970 through the Occupational Safety and Health Act. If we look at total cases, that top line, these are all injuries that occur in the workplace, you can see that trend has been downwards over time. If we look at things like lost workday injuries or days away from work, those are markers of more severe injuries, meaning you got hurt, you couldn't work anymore, and you couldn't come right back to work, those have also declined over time. But restricted work, that bottom line, really hasn't declined over time. This would be a case where you're injured and it's bad enough that you can't do your regular job anymore, but you could do a different type of job and still remain at work. Deaths in the workplace is another way we can look at changes due to occupational health policies. This graphic here is displaying fatalities that occurred in coal or non-coal mines in the United States over time. I'd like to highlight a couple of things here. One, you can see that the bars and the trend lines both absolutely fall over time, indicating we're killing less workers now than we were at the start of this period. The other thing is you'll see some gray boxes on this graph. Those correspond to major legislation that was passed to make mining more healthy and safe. You'll see after each of those legislation efforts, there's been a subsequent decline in the death rate. Here's an example of things getting safer over time, and we can actually start to tease out what sort of influence the policy had. Another thing we can consider in terms of occupational health policy is changes in exposure. I'll talk to you for a moment here about asbestos. Asbestos is, of course, a very potent lung carcinogen. What we're looking at on this graph is the amount of asbestos used in the United States between 1900 and 2010. You'll see between 1910 and about 1970, the amount of asbestos we used steadily climbed. But starting in the mid-1960s, OSHA and its predecessor agencies started to establish limits on how much asbestos could be in the air in a workplace. You'll see as those limits steadily ratcheted down allowing lower and lower exposures, the amount of asbestos also rapidly declined. Here's a case where we effectively regulated asbestos out of the workplace environment and improved occupational health as a result. But despite these gains, I want to come back to a very important point. We've talked in a previous module about how many chemicals are in US commerce, about 85,000. OSHA has PELs. Those are permissible exposure limits for only about 500 chemicals. Most of those 500 are based on 1968 knowledge. In fact, since 1971, OSHA has only established new limits for about 30 hazards. They've proposed many more, but each time they do, they end up in court. Sometimes the process can take more than a decade. Sometimes they have to limit. They're a small agency with limited resources. They've had minimal success here. They acknowledge this. In fact, I've taken some text from the OSHA website. "OSHA recognizes that many of its PELs are outdated and inadequate for ensuring protection of worker health." To paraphrase here, industrial experience, new technology, new science clearly indicate that in many instances, OSHA's limits are not sufficiently protective of worker health. OSHA's PELs remain in effect, but OSHA recommends that employers consider using other alternative exposure limits because the agency believes their own limits may be hazardous to workers. Can you imagine another federal agency telling you, well, this is the law, but even we don't believe this is safe? Yet this is where we find ourselves with the situation with OSHA. We've made great progress, but there's still tremendous work to be done. I'd like to end on a high note here and highlight the occupational health research and training opportunities right here at the University of Michigan. We have one of 18 education and research centers sponsored by the National Institute for Occupational Safety and Health. This training center here at UM is designed to help train occupational health professionals to go out and protect workers. This involves funding for research, but it also involves funding for training, for example, for a master's degree. If you're interested in the idea of specializing in occupational health and safety, I'd encourage you to visit the link on the slide.
