11

Costs of Occupational Injury Costs of Occupational Injury

and Illness Combining All and Illness Combining All

IndustriesIndustries

By J. Paul Leigh, Professor of Health EconomicsBy J. Paul Leigh, Professor of Health Economics

Center for Healthcare Policy and Research, Department of Center for Healthcare Policy and Research, Department of Public Health, University of California, Davis, MS1C. Public Health, University of California, Davis, MS1C.

One Shields Ave, Davis, California, 95616-8638One Shields Ave, Davis, California, 95616-8638Phone: 530-754-8605Phone: 530-754-8605Fax: 530-752-3239Fax: 530-752-3239Email: Email: pleigh@ucdavis.edupleigh@ucdavis.edu

for November 3, 2008 Seminar for Western Center for Agriculture Health and Safety

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Outline for TalkOutline for Talk

IntroductionIntroduction

Second, methods and estimates of costs for occupational Second, methods and estimates of costs for occupational

injury and illness injury and illness

Third, estimates for AgricultureThird, estimates for Agriculture

Fourth, under-reporting cases to Bureau of Labor Statistics Fourth, under-reporting cases to Bureau of Labor Statistics

Fifth, cost-shifting Fifth, cost-shifting

Sixth, interesting data on dangerous jobsSixth, interesting data on dangerous jobs

Seventh, time-trend in reported injuries Seventh, time-trend in reported injuries

Eighth, free market proposal to provide OSH information to Eighth, free market proposal to provide OSH information to

workers, an OSH Report Cards for as many jobs as possibleworkers, an OSH Report Cards for as many jobs as possible

Ninth, conclusionNinth, conclusion

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IntroductionIntroduction

Most Americans between ages 22 and 65 spend 50% Most Americans between ages 22 and 65 spend 50% waking time at work. waking time at work.

Every year millions Americans experience injuries, Every year millions Americans experience injuries, illnesses and even deaths in workplace. illnesses and even deaths in workplace.

Costs occupational injury and illness in 2005 nearly 80% Costs occupational injury and illness in 2005 nearly 80%

as large as cancer, roughly same as diabetes, and greater as large as cancer, roughly same as diabetes, and greater than Alzheimer’s. than Alzheimer’s.

This large size sometimes underestimated since federal This large size sometimes underestimated since federal

government statistics systematically under-count government statistics systematically under-count occupational injury and virtually ignore fatal occupational occupational injury and virtually ignore fatal occupational disease. disease.

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Intro Intro Cont.Cont.

Despite large costs, federal budgets for research and statistics Despite large costs, federal budgets for research and statistics on occupational safety and health are fraction those for cancer, on occupational safety and health are fraction those for cancer, diabetes and Alzheimer’s. diabetes and Alzheimer’s.

Most these costs not absorbed by workers compensation Most these costs not absorbed by workers compensation insurance carriers; they are passed-on to non-workers insurance carriers; they are passed-on to non-workers compensation private medical insurance carriers, to Medicare, to compensation private medical insurance carriers, to Medicare, to Medicaid, and to individual injured workers and their families. Medicaid, and to individual injured workers and their families.

Disproportionate Disproportionate inefficientinefficient number low-income persons number low-income persons experience these injuries. experience these injuries.

Failure to address these costs has number economic Failure to address these costs has number economic consequences since “an ounce of prevention is worth a pound of consequences since “an ounce of prevention is worth a pound of cure.” cure.”

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First, prevention of occupational injuries and illnesses would First, prevention of occupational injuries and illnesses would partially restrain escalating costs of medical care, now pegged at partially restrain escalating costs of medical care, now pegged at 16% of GDP and rising. 16% of GDP and rising.

Second, prevention would decrease high costs of workers’ Second, prevention would decrease high costs of workers’ compensation insurance which now extracts $ 88 billion annually compensation insurance which now extracts $ 88 billion annually from business and government. from business and government.

Third, prevention would improve productivity since there would be Third, prevention would improve productivity since there would be fewer workers who become disabled (father of economics, Adam fewer workers who become disabled (father of economics, Adam Smith, recognized this productivity consequence and called for Smith, recognized this productivity consequence and called for government intervention to reduce occupational hazards).government intervention to reduce occupational hazards).

Fourth, fewer number disabled workers result in fewer federal Fourth, fewer number disabled workers result in fewer federal

dollars spent for Social Security Disability Insurance and fewer dollars spent for Social Security Disability Insurance and fewer dollars spent by state and local governments for welfare. dollars spent by state and local governments for welfare.

Intro Intro Cont.Cont.

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2. National costs of occupational 2. National costs of occupational injury and illness, 2005 injury and illness, 2005 1.a. 1.a. MethodMethod

2.a. Method2.a. Method

Cost-of-Illness method divides costs into direct and indirect Cost-of-Illness method divides costs into direct and indirect

categories categories

Direct costs include medical spending on hospitals, physicians, drugs, Direct costs include medical spending on hospitals, physicians, drugs,

and nursing homes.and nursing homes.

Indirect costs, productivity losses include wage losses and household Indirect costs, productivity losses include wage losses and household

production losses; as well as employer productivity losses, which production losses; as well as employer productivity losses, which

include time spent by supervisors recruiting and training include time spent by supervisors recruiting and training

replacements for injured workers. replacements for injured workers.

Costs were expressed in 2005 dollars Costs were expressed in 2005 dollars

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2.a Method2.a Method

Used epidemiologic method (the population Used epidemiologic method (the population attributable risk, AR model) to estimate numbers and attributable risk, AR model) to estimate numbers and costs of illnesses. costs of illnesses.

Epidemiologic AR method measures portion of Epidemiologic AR method measures portion of prevalence of disease due to particular exposure or prevalence of disease due to particular exposure or risk factor such as benzene, arsenic, or asbestos. risk factor such as benzene, arsenic, or asbestos.

This epidemiologic AR method been applied to many This epidemiologic AR method been applied to many diseases and causes, not just occupational diseases and causes, not just occupational

For example, study estimated if smoking eliminated, For example, study estimated if smoking eliminated, prevalence pneumonia decline by 32% prevalence pneumonia decline by 32%

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2.a Method, 2.a Method, Cont.Cont.

We (Steve Markowitz and Marianne Fahs) developed We (Steve Markowitz and Marianne Fahs) developed estimates for 1992. estimates for 1992.

For this lecture, generated For this lecture, generated preliminarypreliminary estimates for estimates for

2005, extrapolated from 1992 estimates based on 2005, extrapolated from 1992 estimates based on growth or reduction in prevalence or incidence of growth or reduction in prevalence or incidence of illnesses and injuries as well as inflation. illnesses and injuries as well as inflation.

Despite Despite preliminarypreliminary nature of estimates, believe nature of estimates, believe conclusions drawn (e.g. comparing these costs to costs conclusions drawn (e.g. comparing these costs to costs of cancer or diabetes) still hold. of cancer or diabetes) still hold.

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2.b Estimates2.b Estimates Estimates for diseases presented first; injuries second; diseases and Estimates for diseases presented first; injuries second; diseases and

injuries combined, third.injuries combined, third.

Table 1 lists costs of diseases attributed to job-exposures. Table 1 lists costs of diseases attributed to job-exposures.

All disease age ranges had lower limit of age 25. Most had no upper All disease age ranges had lower limit of age 25. Most had no upper limit with exception of circulatory disease, upper age limit of 64. limit with exception of circulatory disease, upper age limit of 64.

In addition to fatal diseases, nonfatal illnesses measured in Bureau of In addition to fatal diseases, nonfatal illnesses measured in Bureau of Labor Statistics (BLS) files. BLS illness data included carpal tunnel Labor Statistics (BLS) files. BLS illness data included carpal tunnel syndrome, dermatitis and tendonitis, many others. syndrome, dermatitis and tendonitis, many others.

Job-related osteoarthritis most frequently develops after age 60, and Job-related osteoarthritis most frequently develops after age 60, and can be attributed to an on-the-job injury. Typical case, worker can be attributed to an on-the-job injury. Typical case, worker seriously injures knee on-the-job age 40 develops osteoarthritis in seriously injures knee on-the-job age 40 develops osteoarthritis in knee age 70. Knee may be replaced, expensive. knee age 70. Knee may be replaced, expensive.

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2.b Estimates, 2.b Estimates, Cont.Cont.

Greatest contributors in Table 1 are cancer, Greatest contributors in Table 1 are cancer, circulatory disease, respiratory disease and job-circulatory disease, respiratory disease and job-related arthritis. The number job-related deaths related arthritis. The number job-related deaths Table 1 sums 66,239. Total costs including job-Table 1 sums 66,239. Total costs including job-related osteoarthritis and nonfatal illnesses: related osteoarthritis and nonfatal illnesses: $49.1266 billion in 2005. $49.1266 billion in 2005.

Workers compensation not likely cover fatal diseases Workers compensation not likely cover fatal diseases or job-related osteoarthritis since diseases do not or job-related osteoarthritis since diseases do not manifest until retirement. manifest until retirement.

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Table 1

Diseases and Costs, 2005, Preliminary Estimates

Disease ICD-9 CodesPercent Attributed To Jobs

Estimated Job-RelatedDeaths

Estimated Job Related Costs (Billions$2005)

1 Cancer 140-209 8% 44,445 $16.3293

2 Circulatory disease(heart and stroke)

410-414, 430438, 440

10% 7155 $4.5070

3 Chronic obstructivepulmonary disease

and asthma

490-496 10% 11,880 $6.4660

4. Pneumonoconioses 500- 505 100% 1136 $0.1268

5. Nervous system disorders

323.7, 331, 332,349.82, 356,357.7, 359.4

2% 712 $0.1985

6. Renal disease 580-589 2% 911 $0.4586

7. Osteoarthritis 715 8% 0 $14.4652

8. Non-fatal illnesses from BLS

N/A 100% 0 $6.5752

TOTAL 66,239 $49.1266

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Estimates for Estimates for Agriculture, 2005Agriculture, 2005

InjuriesInjuries

Number of nonfatalNumber of nonfatal 263,757263,757

at least 1 day work lossat least 1 day work loss 145,061145,061

FatalitiesFatalities 641641

CostCost

TotalTotal $3.74 billion$3.74 billion

DirectDirect $1.367 billion$1.367 billion

IndirectIndirect $2.373 billion$2.373 billion

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Also updated 1992 fatal and nonfatal injury estimates to 2005. Also updated 1992 fatal and nonfatal injury estimates to 2005.

Adjusting fatalities yielded 5,876 deaths and $5.007 billion in Adjusting fatalities yielded 5,876 deaths and $5.007 billion in costs. costs.

Adjusting nonfatal injuries yielded 8,181,583 number of cases Adjusting nonfatal injuries yielded 8,181,583 number of cases and $110.0706 billion in costs. and $110.0706 billion in costs.

Combining two injury costs yielded $115.0776 billion.Combining two injury costs yielded $115.0776 billion.

Combined estimates appear in Table 2.Combined estimates appear in Table 2.

Assuming same percentage difference between direct and Assuming same percentage difference between direct and indirect costs in 2005 as were estimated in 1992, estimated 66% indirect costs in 2005 as were estimated in 1992, estimated 66% or $108.8 billion for indirect costs and $54.5 of direct costs.or $108.8 billion for indirect costs and $54.5 of direct costs.

2.b Estimates, 2.b Estimates, Cont.Cont.

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Table 2

Number and Cost for Job-Related Injuries and Illnesses in US($Billions) 2005, Preliminary Estimates

Number Costs, billions

I Injuries 8,186,792 $115.0776

A. Deaths 5,876 $5.0070

B. Nonfatal 8,180,916 $110.0706

II. Illnesses $49.1266

A. Deaths 66,239 $28.0862

B. Nonfatal injuries 726,325 $6.5752

C. Job-related arthritis $14.4652

III. Grand total $163.2042

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2.c 2.c

ComparisonsComparisons

Liberty Mutual, one largest workers’ compensation insurance Liberty Mutual, one largest workers’ compensation insurance carriers in US. carriers in US.

They estimated direct and indirect costs (not just those covered by They estimated direct and indirect costs (not just those covered by workers’ compensation) from $155 billion to $232 billion in 1998. workers’ compensation) from $155 billion to $232 billion in 1998.

(One reason Liberty Mutual’s estimates exceed ours is they allow (One reason Liberty Mutual’s estimates exceed ours is they allow for more categories of productivity costs to employers such as for more categories of productivity costs to employers such as overtime pay).overtime pay).

My estimates and Liberty Mutual’s indicate higher percentage of My estimates and Liberty Mutual’s indicate higher percentage of indirect costs to total costs when compared other diseases such as indirect costs to total costs when compared other diseases such as heart disease or cancer. heart disease or cancer.

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2.c Comparisons 2.c Comparisons Cont.Cont.

Reason for high indirect costs is over 70% of occupational costs due Reason for high indirect costs is over 70% of occupational costs due injuries; more harm to younger persons than are accounted for by injuries; more harm to younger persons than are accounted for by diseases. diseases.

Occupational injury deaths frequently occur among persons their 20s, Occupational injury deaths frequently occur among persons their 20s, 30s and 40s whereas cancer and especially heart disease deaths 30s and 40s whereas cancer and especially heart disease deaths occur among persons in their 60s, 70s and 80s. occur among persons in their 60s, 70s and 80s.

Whereas all deaths are losses, deaths among younger persons mean Whereas all deaths are losses, deaths among younger persons mean many more years of productive life lost than deaths of older persons. many more years of productive life lost than deaths of older persons.

Moreover, deaths among parents with young children especially Moreover, deaths among parents with young children especially tragic. Neither our estimates nor those from Liberty Mutual account tragic. Neither our estimates nor those from Liberty Mutual account for emotional costs to young children losing parent.for emotional costs to young children losing parent.

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Occupational injury and illness costs large when compared to Occupational injury and illness costs large when compared to other diseases. other diseases.

Costs cancer in 2005, $210 billion. Our costs estimates ($163 Costs cancer in 2005, $210 billion. Our costs estimates ($163 billion) roughly 78% as large as for cancer. Upper range billion) roughly 78% as large as for cancer. Upper range Liberty Mutual’s estimates exceed cancer. Liberty Mutual’s estimates exceed cancer.

Costs diabetes 2007, $174 billion. Accounting for inflation our Costs diabetes 2007, $174 billion. Accounting for inflation our estimates on a par with diabetes. Upper range Liberty Mutual estimates on a par with diabetes. Upper range Liberty Mutual estimates exceed diabetes. estimates exceed diabetes.

Costs of Alzheimer’s Disease, $148 billion. Our $163 billion Costs of Alzheimer’s Disease, $148 billion. Our $163 billion exceeds.exceeds.

2.c Comparisons Cont.2.c Comparisons Cont.

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Comparisons, federal government funding for health research.Comparisons, federal government funding for health research. National Institute for Occupational Safety and Health (NIOSH) National Institute for Occupational Safety and Health (NIOSH)

consistently received among smallest amounts funding consistently received among smallest amounts funding compared to other institutes. compared to other institutes.

2006 fiscal year funding for NIOSH was $254 million 2006 fiscal year funding for NIOSH was $254 million

$4,793 million (19 times NIOSH) for National Cancer Institute$4,793 million (19 times NIOSH) for National Cancer Institute

$1,844 million (7.3 times NIOSH) for National Institute $1,844 million (7.3 times NIOSH) for National Institute Diabetes, Digestive, Kidney Diabetes, Digestive, Kidney

$508 million (2 times) National Institute of Arthritis and $508 million (2 times) National Institute of Arthritis and Musculoskeletal Disorders.Musculoskeletal Disorders.

2.c Comparisons Cont.2.c Comparisons Cont.

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3. 3. UndercountUndercount

Number of studies indicate BLS’s estimates of numbers Number of studies indicate BLS’s estimates of numbers nonfatal injuries and illnesses significantly below actual. nonfatal injuries and illnesses significantly below actual.

BLS may miss from 20% to 70% nonfatal injuries and BLS may miss from 20% to 70% nonfatal injuries and illnesses.illnesses.

In part, due to BLS exclusion self-employed and In part, due to BLS exclusion self-employed and government workers.government workers.

More important are exclusions of cases private firms do More important are exclusions of cases private firms do not report to BLS. not report to BLS.

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3. Undercount 3. Undercount Cont.Cont.

First, firms have economic incentive to under-report. First, firms have economic incentive to under-report.

Some experience-rated workers’ compensation systems penalize Some experience-rated workers’ compensation systems penalize firms with high premiums if report high numbers injuries. firms with high premiums if report high numbers injuries.

Firms may want government contracts and want look attractive Firms may want government contracts and want look attractive to government agencies to government agencies

But not just firms. But not just firms.

Employees may voluntarily decline to report for fear of being Employees may voluntarily decline to report for fear of being labeled accident-prone or fear denied a promotion. labeled accident-prone or fear denied a promotion.

Finally, undercount may have resulted from increasing number of out-Finally, undercount may have resulted from increasing number of out-sourcing firms who employ contingent workers (#1 ref. Cummins). sourcing firms who employ contingent workers (#1 ref. Cummins).

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Greatest data gap in government statistics lies with Greatest data gap in government statistics lies with measuring fatal occupational fatal disease. measuring fatal occupational fatal disease.

Information available on coal workers’ pneumoconiosis, Information available on coal workers’ pneumoconiosis, silicosis, byssinosis, and mesothelioma. silicosis, byssinosis, and mesothelioma.

But these comprise fewer than 5% all occupational But these comprise fewer than 5% all occupational disease deaths. disease deaths.

In my view, more resources should be devoted to data-In my view, more resources should be devoted to data-gathering for fatal occupational disease. gathering for fatal occupational disease.

3. Undercount Cont.3. Undercount Cont.

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4. How much of the costs do Workers 4. How much of the costs do Workers Compensation insurers cover? Who Compensation insurers cover? Who pays for the rest? Implications for cost pays for the rest? Implications for cost shiftingshifting

Workers Compensation insurers paid $55.3 billion for Workers Compensation insurers paid $55.3 billion for medical care and indemnity payments in 2005. medical care and indemnity payments in 2005.

Comparison to our estimates suggests t 66% of costs, or Comparison to our estimates suggests t 66% of costs, or $108 billion, not covered by workers compensation. $108 billion, not covered by workers compensation.

Who pays when workers compensation does not? Short Who pays when workers compensation does not? Short answer is “everybody else.” answer is “everybody else.”

Likely that medical costs absorbed by existing payment Likely that medical costs absorbed by existing payment mechanisms outside workers compensation. mechanisms outside workers compensation.

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4. Workers Compensation 4. Workers Compensation Cont.Cont.

Using figures from National Center for Health Statistics Using figures from National Center for Health Statistics (NCHS), roughly 15% will be out-of-pocket, 40% will be (NCHS), roughly 15% will be out-of-pocket, 40% will be private health insurance, 33% will be Medicare, 10% will be private health insurance, 33% will be Medicare, 10% will be Medicaid and 2% will be “other.”Medicaid and 2% will be “other.”

If $108 is not covered, and 33% of $108 is direct costs, then If $108 is not covered, and 33% of $108 is direct costs, then

$36 billion will be spread across the NCHS categories.$36 billion will be spread across the NCHS categories. Roughly $14.4 billion will be paid by non-workers’ Roughly $14.4 billion will be paid by non-workers’

compensation private insurance. compensation private insurance.

Roughly $15.6 billion will be paid by taxpayers: Medicare Roughly $15.6 billion will be paid by taxpayers: Medicare ($12 billion), Medicaid ($3.6 billion). ($12 billion), Medicaid ($3.6 billion).

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Bulk uncovered indirect costs ($72 billion) absorbed by Bulk uncovered indirect costs ($72 billion) absorbed by individual workers and families but also by the economy at individual workers and families but also by the economy at large, since more disabled workers will mean less output. large, since more disabled workers will mean less output.

Some indirect costs also absorbed by Social Security Some indirect costs also absorbed by Social Security Disability Insurance. Disability Insurance.

Reville and Schoeni (#2 ref.) find “among Disability Reville and Schoeni (#2 ref.) find “among Disability Insurance recipients, 45 percent of men and 26 percent of Insurance recipients, 45 percent of men and 26 percent of women are disabled because of workplace accidents, women are disabled because of workplace accidents, injuries, or illnesses. The annual cost of workplace injuries injuries, or illnesses. The annual cost of workplace injuries to Medicare and Social Security Disability Insurance is to Medicare and Social Security Disability Insurance is roughly $33 billion.”roughly $33 billion.”

Economic implications for substantial cost-shifting. Economic implications for substantial cost-shifting.

4. Workers Compensation Cont.4. Workers Compensation Cont.

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4. Workers Compensation 4. Workers Compensation Cont.Cont.

Poor health of workers viewed as economic externality, an Poor health of workers viewed as economic externality, an unwelcome by-product of production, similar to air pollution.unwelcome by-product of production, similar to air pollution.

Economic efficiency requires that private costs of production equal Economic efficiency requires that private costs of production equal

social costs. social costs.

If private costs too low, firms will produce inefficient amount (too If private costs too low, firms will produce inefficient amount (too much) pollution or, in our case, too many occupational injuries. much) pollution or, in our case, too many occupational injuries.

Aggregate private costs, reflected by workers compensation Aggregate private costs, reflected by workers compensation premiums, are too low. premiums, are too low.

If premiums higher, and if firms experienced-rated so that they If premiums higher, and if firms experienced-rated so that they face true costs, then they firms would have economically face true costs, then they firms would have economically appropriate incentive to reduce injuries. appropriate incentive to reduce injuries.

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This reduction likely involve prevention strategies. This reduction likely involve prevention strategies.

This prevention would mean reduction in costs borne by This prevention would mean reduction in costs borne by private non-workers compensation medical insurance private non-workers compensation medical insurance carriers, Medicare and Medicaid. carriers, Medicare and Medicaid.

Given the high and rising cost of medical care (currently Given the high and rising cost of medical care (currently 16% of GDP) this trade-off of more prevention spending 16% of GDP) this trade-off of more prevention spending for less cure spending would be welcome. for less cure spending would be welcome.

4. Workers Compensation Cont.4. Workers Compensation Cont.

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5. Interesting Data on 5. Interesting Data on Dangerous JobsDangerous Jobs

For many workers in jobs with especially high fatal injury For many workers in jobs with especially high fatal injury rates, hazards likely well-known. e.g. police officers, rates, hazards likely well-known. e.g. police officers, firefighters, fishers, airplane pilots, US Presidents. firefighters, fishers, airplane pilots, US Presidents.

But the list of well-know dangerous jobs is short. But the list of well-know dangerous jobs is short.

Most consumers know more about the fat content of the Most consumers know more about the fat content of the potato chips before they purchase them than prospective potato chips before they purchase them than prospective workers know about job hazards before they take them. workers know about job hazards before they take them.

The list of high death-injury rate jobs that are not well-know The list of high death-injury rate jobs that are not well-know is long.is long.

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5. Interesting Data 5. Interesting Data Cont.Cont.

The occupation list includes surveying assistants, laborers, farm The occupation list includes surveying assistants, laborers, farm workers, apprentices in construction trades, garbage collectors, workers, apprentices in construction trades, garbage collectors, warehouse workers, bakers, geologists, truck drivers, mechanics, warehouse workers, bakers, geologists, truck drivers, mechanics, gas-station attendants, delivery workers, driver-sales workers, metal gas-station attendants, delivery workers, driver-sales workers, metal molders, and convenience store clerks, to name a few. molders, and convenience store clerks, to name a few.

The industry list includes trucking, fats and oils, care dealers, The industry list includes trucking, fats and oils, care dealers, warehousing, dairy products, bakery products, and real estate. warehousing, dairy products, bakery products, and real estate.

But these lists do not account for non-fatal injuries. But these lists do not account for non-fatal injuries.

One of most hazardous jobs for women is nursing aide at nursing One of most hazardous jobs for women is nursing aide at nursing homes. Relatively small female aides required to transport relatively homes. Relatively small female aides required to transport relatively large men from beds to gurneys and back again. Back injuries large men from beds to gurneys and back again. Back injuries result. In addition, some of these men are demented and violent. result. In addition, some of these men are demented and violent.

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There are unexpected differences in the sizes of fatal and There are unexpected differences in the sizes of fatal and nonfatal injury rates across occupations and industries. nonfatal injury rates across occupations and industries.

For occupations, roofers, truck drivers and farm workers have For occupations, roofers, truck drivers and farm workers have fatality rates roughly 80% larger than police officers. fatality rates roughly 80% larger than police officers.

Construction laborers have a fatality rate nearly double that of Construction laborers have a fatality rate nearly double that of police.police.

Groundskeepers and welders have higher fatality rates than Groundskeepers and welders have higher fatality rates than

carpenters. carpenters.

For nonfatal rates resulting in days away from work, cashiers For nonfatal rates resulting in days away from work, cashiers have higher rates than cooks who exceed stock handlers and all have higher rates than cooks who exceed stock handlers and all three exceed non-construction laborers. three exceed non-construction laborers.

5. Interesting Data Cont.5. Interesting Data Cont.

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Also surprising methods whereby workers experience Also surprising methods whereby workers experience injury deaths on the job. injury deaths on the job.

Convenience store clerks, cashiers at liquor stores, Convenience store clerks, cashiers at liquor stores, restaurant managers, receptionists and lawyers are restaurant managers, receptionists and lawyers are frequently murdered. frequently murdered.

Nearly as many vehicle crashes kill police officers as Nearly as many vehicle crashes kill police officers as violent attacks. violent attacks.

Farm workers and garbage collectors most frequently Farm workers and garbage collectors most frequently die of vehicle crashes. die of vehicle crashes.

5. Interesting Data Cont.5. Interesting Data Cont.

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5. Interesting Data Cont.5. Interesting Data Cont.

In general, vehicle crashes and homicide account for In general, vehicle crashes and homicide account for far more on-the-job injury deaths than is usually far more on-the-job injury deaths than is usually imagined. Studies show that even coroners fail to imagined. Studies show that even coroners fail to recognize homicides and vehicle crash deaths as job-recognize homicides and vehicle crash deaths as job-related. related.

Not just employees. The self-employed have one of the Not just employees. The self-employed have one of the highest rates for fatal injury of all job classifications. highest rates for fatal injury of all job classifications. Small firms, in general, have high fatality rates.Small firms, in general, have high fatality rates.

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List of ten (nonfatal number of cases and average wage, for 2005 and 2006)List of ten (nonfatal number of cases and average wage, for 2005 and 2006)

are as follows: laborers and freight, stock, and material movers (92,240, $11.08)are as follows: laborers and freight, stock, and material movers (92,240, $11.08)

Truck drivers, heavy and tractor-trailer (65,930, $17.46)Truck drivers, heavy and tractor-trailer (65,930, $17.46) Nursing aides, orderlies, and attendants (52,150, $11.04) Nursing aides, orderlies, and attendants (52,150, $11.04)

Construction laborers (39,270, $14,39) Construction laborers (39,270, $14,39)

Truck drivers, light and delivery services (32,740, $13.23)Truck drivers, light and delivery services (32,740, $13.23) Retail salespersons (32,300, $11.51) Retail salespersons (32,300, $11.51)

Janitors and cleaners, except maids and housemen (31,440, $10.45)Janitors and cleaners, except maids and housemen (31,440, $10.45)

Carpenters (31,270, $19.20) Carpenters (31,270, $19.20)

Maintenance and repair workers, general (23,170,$16.11)Maintenance and repair workers, general (23,170,$16.11)

Stock clerks and order filers (23,060, $10.79) Stock clerks and order filers (23,060, $10.79)

With the exception of carpenters’ wages, the remaining nine of these With the exception of carpenters’ wages, the remaining nine of these

“ “top 10” wages are well below the average for the nation, $18.84.top 10” wages are well below the average for the nation, $18.84.

5. Interesting Data Cont.5. Interesting Data Cont.

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6. Trend6. Trend

Has been downward time trend for numbers and rates of Has been downward time trend for numbers and rates of occupational injury (but not disease). occupational injury (but not disease).

roughly 8% reduction for injury deaths occurred from 1992 to roughly 8% reduction for injury deaths occurred from 1992 to 2005 and 38% reduction for nonfatal2005 and 38% reduction for nonfatal cases from 1994 to 2005cases from 1994 to 2005. .

Lead someLead some observers toobservers to suggest “nothing more needs to be suggest “nothing more needs to be

done,” since time will obviate OSH problems. done,” since time will obviate OSH problems.

At least three responses. At least three responses.

First, academic researchers question whether and how much First, academic researchers question whether and how much reduction there has actually been, especially given controversy reduction there has actually been, especially given controversy about BLS undercount. about BLS undercount.

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6. Trend Cont.6. Trend Cont. One study found 83% of BLS reported decline due to changes in One study found 83% of BLS reported decline due to changes in

OSHA record-keeping rules. OSHA record-keeping rules.

Second, for other diseases, just because downward trend does not Second, for other diseases, just because downward trend does not mean we quit. mean we quit.

Breast cancer mortality for white women slowly but steadily Breast cancer mortality for white women slowly but steadily dropping, perhaps 25%, since 1984. Yet the NCI funding for breast dropping, perhaps 25%, since 1984. Yet the NCI funding for breast cancer research has been increasing. cancer research has been increasing.

The same true for heart disease. The age-adjusted death rate for The same true for heart disease. The age-adjusted death rate for heart disease dropped 42% from 1980 to 2002 but funding for the heart disease dropped 42% from 1980 to 2002 but funding for the National Heart Lung and Blood Institute has expanded from 1980 National Heart Lung and Blood Institute has expanded from 1980 to 2002. to 2002.

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As breast cancer and heart disease deaths drop we As breast cancer and heart disease deaths drop we congratulate funding agencies and reward with more congratulate funding agencies and reward with more resources. resources.

We should do same for occupational safety and health. We should do same for occupational safety and health.

Third response is: no evidence that numbers fatal Third response is: no evidence that numbers fatal occupational diseases (66,239 in 2005) falling over occupational diseases (66,239 in 2005) falling over time. time.

6. Trend Cont.6. Trend Cont.

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7. Free-Market 7. Free-Market ProposalProposal

Low-cost suggestion: require health and safety Low-cost suggestion: require health and safety information attached to job application forms. information attached to job application forms.

Like most economists, believer in free markets. Like most economists, believer in free markets.

As all economists acknowledge, free market efficiency As all economists acknowledge, free market efficiency enhanced with better information. enhanced with better information.

Today, information on job hazards workers can easily Today, information on job hazards workers can easily grasp sadly lacking. grasp sadly lacking.

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7. Free-Market 7. Free-Market Proposal Cont.Proposal Cont.

For example, do not believe most clerks in convenience stores realize risks For example, do not believe most clerks in convenience stores realize risks of murder higher than those for police officers. of murder higher than those for police officers.

Do not believe most women seeking jobs as aides in nursing homes realize Do not believe most women seeking jobs as aides in nursing homes realize nursing home aides experience more serious injuries than women in any nursing home aides experience more serious injuries than women in any other job in the country. other job in the country.

We know more about the health content of potato chips before we We know more about the health content of potato chips before we purchase them (thanks to federally-mandated nutrition content notices) purchase them (thanks to federally-mandated nutrition content notices) than we do about the health and safety content of jobs before we take than we do about the health and safety content of jobs before we take them. them.

I think every job application form should carry a page of information and I think every job application form should carry a page of information and statistics---including death rates---particular to specific occupations and statistics---including death rates---particular to specific occupations and industries relevant to the job applicant. This would permit prospective industries relevant to the job applicant. This would permit prospective workers to turn down dangerous jobs, thus providing a free market workers to turn down dangerous jobs, thus providing a free market incentive for employers to improve job safety. incentive for employers to improve job safety.

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8. 8. ConclusionConclusion

Costs of occupational injuries and illnesses high, Costs of occupational injuries and illnesses high, almost as much as cancer.almost as much as cancer.

30%-70% under report el BLS30%-70% under report el BLS

Cost shift lead to inefficiencyCost shift lead to inefficiency

OSHA & NIOSH should be rewarded for down trendOSHA & NIOSH should be rewarded for down trend

Death rates on job application forms should improve Death rates on job application forms should improve free market.free market.