Editor’s note:​ This article is the third in a series about the need for industrial hygienists to expand their perspective regarding matters of risk. Other articles in the series include “Shifting the Conversation” in the April 2015 issue and “Characterizing Risk” in the September 2015 issue.
Much of our professional perspective on risk is rooted in a historical approach involving assessment of exposures against an array of exposure limits. These limits include occupational (PELs, RELs, DNELs, exposure banding), non-occupational (NAAQS, ASHRAE, AHERA), and other levels such as Acute Exposure Guideline Levels (AEGLs) and AIHA’s Emergency Response Planning Guidelines (ERPGs). We are finding, however, that simply answering the question “Are we above or below the limit?” is no longer enough to meet our employers’ and clients’ risk management needs. AIHA’s Content Portfolio Management Team recognizes this problem and has acknowledged that the topic of risk is much broader than exposure. A session at AIHA’s Fall Conference in October explored the improvement of worker health, both on and off the job, and our professional role and challenges with such a mission. Key points in the previous articles in this Synergist series were developed further in the kick-off presentation, namely that expanding the profession’s risk perspective will require new language and context. This need was reinforced in a case study from Johnson & Johnson about its success incorporating elements of the NIOSH Total Worker Health (TWH) initiative, and presentations that discussed NIOSH’s Cumulative Risk Assessment (CRA) efforts and the risk assessment challenges facing small businesses. The session demonstrated that risk is multifaceted and complex, and spans every aspect of human activity. TOWARD A NEW RISK MODEL Such a broad and forward-looking view of risk is seen in the NIOSH TWH and CRA initiatives. The concept of TWH embodies a holistic approach to the well-being of workers. It acknowledges that health problems unrelated to work, such as those from smoking, have tremendous impact on workplace health and costs, and TWH engages individual workers to care about their own health and safety by offering integrated systems and programs at the employer’s expense. CRA is the practice of examining multiple contributions to exposure when we make decisions about risk. To date, most work on CRA has focused on environmental risk assessments; EPA, for example, uses CRA to address the effects of multiple environmental chemical exposures occurring simultaneously. NIOSH is working to integrate all risk factors—personal, environmental, and occupational—into CRA. Both TWH and CRA stem from the understanding that the health of workers on the job and the public off the job are inextricably intertwined. Worldwide trends are making the boundaries between the workplace and the community less distinct; NIOSH and EPA, together with labor, academics, and consultants, have responded by seeking to replace conventional siloed models of risk (Figure 1) with an integrated risk model (Figure 2) that focuses on the well-being of the individual and recognizes the interactions of occupational, environmental, individual, and societal risks. To that end, NIOSH is leading an effort to publish peer-reviewed journal articles that address occupational risk factors (ORF) in aggregate (cumulative) risk assessments.
PERCEPTIONS OF RISK During a party last June for approximately 4,000 young people at the Formosa Fun Coast Water Park in Taipei, Taiwan, a colored powder sprayed onto the crowd suddenly ignited, causing hundreds of injuries and at least fifteen deaths. The powder, a mixture of cornstarch and food dye, was similar to those used at popular “color run” events, where participants are periodically doused with colors as they run or walk along a five-kilometer course. This tragedy alarmed many in the public who weren’t aware that cornstarch, a familiar foodstuff, was also a combustible dust. Officials in locations that planned to hold color runs also expressed concern for public safety. But as Guy Colonna of the National Fire Protection Association explained at AIHA’s Fall Conference in October, this well-meaning concern was misplaced. The officials’ impulse was to regulate color runs based on the ambient temperature under the false assumption that hot weather, rather than the dust cloud concentrations, caused the powder used at Fo​rmosa to ignite. ​ This example illustrates a common problem for industrial hygienists. We regularly encounter similar misconceptions about the relationship between hazard and risk, and we sometimes struggle to explain why someone’s intuitive understanding of science—something as common as cornstarch can’t be flammable—is often wrong. For these reasons, the topic of risk—even when it concerns an event, like a color run, that lies outside the realm of health protection—is clearly within the domain of our profession. Because of our training and background, no one is better suited to communicate about risk with the general public and other audiences, including professionals such as safety officials. In this way, risk communication represents a significant opportunity for our profession to have a broader impact beyond the workplace.
Total Worker Health and Cumulative ​Risk Assessment: A Vision for the Future
Figure 1. “Siloed” Risk Model
Figure 2. “Holistic” Risk Model
TOTAL WORKER HEALTH IN PRACTICE TWH expands traditional occupational safety and health to include wellness and well-being. This concept has been put into practice at Johnson & Johnson, the multinational manufacturer of medical devices and pharmaceutical goods, with significant benefits not only to the health of employees but to the bottom line. Johnson & Johnson’s approach to TWH includes work-life integration, healthy lifestyle programs, mental health and well-being, value-added on-site services, occupational health, disease management, and energy management. Compared to the general population and corporate peers, Johnson & Johnson employees have lower health risks and overall better health both on and off the job. Improved employee health has also resulted in significant savings. Since 2002, Johnson & Johnson has reduced the growth of its healthcare cost curve with an estimated ROI of $1.88 to $3.92 per $1.00 spent on employee health and wellness. Such reduced costs benefit both the corporation and employees. While Johnson & Johnson’s example shows the effectiveness of Total Worker Health when put into practice at a multibillion-dollar company, small businesses present a greater challenge due to their limited resources and expertise. Small businesses often struggle with the basics, such as adverse health outcomes from dust, noise, and musculoskeletal stress. For these reasons, workers in small businesses face a higher risk of injury and fatality than workers in large companies. But small businesses also represent a significant opportunity for industrial hygienists. In 2012, nearly half (49 percent) of all U.S. workers were employed by small businesses, according to the U.S. Census Bureau. Worldwide, small businesses employ between 33 and 66 percent of all workers, depending on country and year of the data. Clearly, if we can improve health outcomes at small businesses, we will be reaching a significant portion of the working public. The Institute for Work and Health, a nonprofit research organization based in Toronto, published an analysis of small business and occupational health in 2008. The data was obtained from published academic literature and covered 10 sectors (including construction, manufacturing, and agriculture) in Canada, the U.S., Brazil, Nigeria, and other countries. Researchers found that small businesses in these diverse areas face common challenges such as lack of knowledge of rules and approaches to workplace health, tight profit margins, lack of formal systems (including management systems), a high appetite and reward for risk taking, and a work culture with limited perspective. The report recommends that industrial/occupational hygiene professionals pay attention to consider the complexity of small business processes and social relations, and implement multi-factor interventions to achieve change and improvement. Other approaches suggested to address workplace health in a small business include developing knowledge of and the business case for workplace health in sector- specific trade organizations; improving education of K through 12 students in all aspects of workplace health as well as targeting workplace health instruction to individuals studying specific trades such as welding, construction management, and cosmetology; and engaging consumers in being knowledgeable and mindful of the health risks and fatalities in the workplace. Clearly, these recommendations extend well beyond the plant fence-line. A COLLECTIVE VISION OF RISK We all make risk decisions, on and off the job—often independently of empirical data. The challenge facing the general public, workers, and industrial hygiene professionals is to figure out how to balance voluntary habits with involuntary risks and create a method of evaluating and judging all stressors, risk factors, benefits, rewards, and outcomes. By framing risk more broadly, as seen in TWH and CRA, we have a means to increase engagement in risk topics and apply our limited resources to areas where we can achieve the greatest benefit. But shifting the mindset on risk doesn’t come easily: it took decades, for example, to prohibit cigarette smoking in workplaces, bars, restaurants, and airplanes. Nevertheless, these initiatives and others are helping industrial/occupational hygiene professionals develop a collective vision of risk—one based on integrative, systems-thinking, and which favors commitment instead of compliance. By viewing risk through a broad health lens, we will improve worker health and performance, which in turn will improve organizational health and global well-being. Once limited to occupational risk factors, risk assessment is now increasingly intertwined with environmental and societal factors and influenced by personal choice. As the nature of risk assessment continues to grow, we need to look outside the workplace, and our traditional perspectives and practices, to improve worker and public health. Collaborations are occurring, literature is being created, horizons are expanding, and models need to be validated with demonstrable cost/benefit analysis. Let us continue to broaden our view of risk and the roles in which we can serve beyond exposure. FRED BOELTER, CIH, PE, BCEE, FAIHA, is principal at RHP Risk Management, Inc. in Boise, Idaho. He can be reached at fboelter@rhprisk.com or (312) 560-9113. STEVEN JAHN, CIH, is a technical advisor for Savannah River Nuclear Solutions, LLC in Aiken, S.C. He can be reached at steven.jahn@srs.gov, jahnindustrialhygiene@gmail.com, or (803) 557-4361. MARY O’REILLY, CIH, PhD, CPE, is an industrial hygienist with ARLS Consultants, Inc., in Manlius, N.Y. She is on the faculty of the SUNY School of Public Health and the board of directors of Workplace Health Without Borders. She can be reached at moreilly@albany.edu or (315) 682-3064.​ CHARLES REDINGER, PhD, MPA, CIH, FAIHA, is president of Redinger 360, Inc. in Harvard, Massachusetts. He can be reached at cfr@redinger360.com or (978) 456-8105. MARCELO TARGINO, MD, MPH, FACOEM, FACP, is medical director for the Americas, Johnson & Johnson Global Health Services in New Brunswick, N.J. He can be reached at mtargino@its.jnj.com.
RESOURCES​ Dotson, G. Scott, and R. Todd Niemeier: “Cumulative Risk Assessment: Bridging the Gap between Well-Being and Occupational Safety and Health” (PDF). Institute for Work and Health: “Effectiveness and Implementation of Health and Safety Programs in Small Enterprises: A Systematic Review of Quantitative and Qualitative Literature” (2008).​ Targino, Marcelo: “J&J Health and Wellness Programs: Turning NIOSH Total Worker Health,” AIHA Fall Conference presentation (2015).
• Focuses on well-being • Recognizes the impact of interactions
• Focuses on well-being • Recognizes the impact of interactions