Raising Health’s Profile
A Battle Plan for the Construction Sector’s Health Hazards
Industrial hygienists know the importance of occupational health. We know the national estimates suggesting that fatal occupational illnesses occur ten times more than fatal occupational injuries. We realize that the costs of these illnesses—whether shouldered by workers and their families, borne by employers affected by lost productivity, or passed along to taxpayers in the form of higher disability costs—tend to be overlooked. We understand that awareness is higher for injuries, which are easier to link to the workplace than occupational diseases. Diseases may not show up for months or years.

Harder to know is what we can do to raise the profile of health. How can we best serve as occupational health champions? These challenging questions motivated a project team from AIHA’s Construction Committee to develop new materials to raise awareness about health and to target common construction health hazards in the United States and Canada. The resulting booklet, called “Focus Four for Health” (PDF), was released in June and is available as a free download to encourage construction stakeholders to join in to improve construction worker health. STRATEGY Construction is relevant for all industrial hygienists because sooner or later every type of workplace needs renovation or new construction. The major focus of EHS programs in construction has been safety. While this is appropriate given the higher-than-average injury and fatality rates in construction, the contrast with occupational health hazards is stark. There are fewer guidance materials, regulations, enforcement actions, and training efforts for health. The inadvertent message received by many employers and workers is that safety is a clear priority, but health is not.  The project team saw an opportunity to build upon an existing safety approach with a strong foothold in the construction industry. The long-running “Focus Four” program, initially launched by OSHA in 1994, is well known by many construction employers and employees. It targets the four top causes of fatal construction injuries: falls, electrocutions, struck-by injuries, and injuries resulting from workers getting caught between objects. OSHA’s Focus Four program has stimulated a wide variety of activities and is credited with helping to bring down fatality rates over time. However, it is silent about health hazards.  The project team created a health companion piece to fit alongside the Focus Four program. We selected four widely prevalent construction health hazards: Manual material handling. Overexertion during lifting, pulling, pushing, and carrying is the top cause of work-related musculoskeletal disorders, which account for about a third of all work-related injuries in construction and about half of all workers’ compensation costs.  Noise. High noise levels can cause hearing loss and tinnitus. Recent findings also suggest links to sleep disturbance, cardiovascular disease, hypertension, depression, and impairment of balance. Almost three-quarters of construction workers in a 2011 study were found to be exposed to noise levels above the recommended exposure limit set by NIOSH. Air contaminants. Dust, fumes, vapors, and gases can cause a variety of short- and long-term health effects, ranging from asthma and irritation to chronic obstructive pulmonary disease, nervous system problems, kidney damage, or even cancer, depending on the material and extent of exposure. More than half of construction workers report being regularly exposed to vapors, gas, dust, or fumes twice a week or more at work. The risk for developing an occupationally related disease after a working lifetime in construction is two to six times greater than for non-construction workers. High temperatures. North American summers during the last decade rank among the hottest on record. Heat stroke is the most severe heat-related illness. It can cause death or permanent disability if not treated quickly. An OSHA study of 20 construction heat illness cases involving 13 deaths found that four occurred on the first day of the job. GUIDANCE The primary target audience is construction employers and workers. The project team believes that secondary audiences such as construction trade organizations, workers’ compensation carriers, and industrial hygiene professionals, consultants, and safety practitioners will also find the guidance useful.  The guidance begins by tackling head-on why health tends to lag behind safety in construction:  Seeing is believing. Injuries and safety hazards are easier to see with the naked eye, while health hazards and most occupational illnesses are much less observable. 
The guidance works to improve employer skills at identifying visually the types of “risk factors” that make exposures more likely for each of the four health hazards.
MATT GILLEN, MS, is an AIHA Fellow, member of AIHA’s Construction Committee, and project team lead for the Focus Four for Health guidance. Editor’s note: This article was originally published on the SynergistNOW blog on July 9, 2019.   Send feedback to The Synergist.

Mixed signals from regulations and inspections. Only about seven percent of all OSHA construction inspections are for health, about one-third the 20 percent rate for general industry.  Mixed signals from a lack of national statistics. Whereas annual national reports describing top causes of traumatic injuries get considerable attention, there are no counterpart reports for occupational illnesses. This lack of attention sends an inadvertent message that health is not a major issue. Next, the guidance presents the four hazard sections. Each follows a similar outline with ten topics. The first three topics orient the reader: What is the hazard? How severe are the health effects and how common are they? What trades are most commonly affected? These sections make the hazards as salient as possible for readers and clarify what the impacts to worker health can be—from cutting careers short to pain, disability, and death. The next two topics—How should we look at this health hazard? and What strategies can be used to control this hazard?—use the safety practice template most likely to be familiar to construction employers: identifying observable risk factors before the job as part of a Job Safety Analysis. Our preference is always to have a professional hygienist assist employers with evaluating exposure potential, but this may not be realistic given that small and medium-sized firms dominate the construction industry (81 percent of the half a million construction establishments have fewer than 10 employees) and the limited information available suggests they seek industrial hygiene consultations at a much lower rate than for safety topics.  The guidance takes an alternative approach. It works to improve employer skills at identifying visually the types of “risk factors” that make exposures more likely for each of the four health hazards. It reinforces how this can be done at the same time employers are identifying safety hazards prior to work. It also provides practical strategies that employers can use to prevent or control likely exposures. Finally, it makes employers aware of how industrial hygienists can help them better understand exposures, especially for cases where overexposures seem most likely.  The Regulations and Guidance topic describes applicable U.S. and Canadian regulations. However, the goal of the guidance is to go beyond compliance to good practice. This is important because regulations do not address topics such as manual material handling and heat stress, and because existing regulations for construction noise and permissible exposure limits are known to be out of date or insufficiently protective.  Two short sections follow: How can trade groups help? and How can an industrial hygienist help? These provide suggestions on how construction organizations can get involved to assist their members, and how industrial hygienists can assist employers with evaluating and controlling each of the four health hazards.  The final topics for each section reiterate key messages and provide useful links to other resources.  CALL TO ACTION The guidance concludes with a short section that suggests specific activities for nine different construction sector groups, including safety and health organizations such as AIHA. For example, AIHA local sections could collaborate with local construction trade associations, labor organizations, and local OSHA offices to conduct workshops and training sessions, or they could work with local tool rental suppliers and vendors to demonstrate quieter tool options and noise measurement apps. The goal of this section is to stimulate activities and partnerships. WHERE DO WE GO FROM HERE? “Focus Four for Health” can help construction employers tackle some of the most common construction health hazards. It provides a vehicle for hygienists to educate safety colleagues and work site trainers about getting involved with health. In sum, it represents an opportunity for all industrial hygienists to raise the profile of occupational health in construction—a worthwhile but long-overdue goal. As industrial hygienists, we must be champions for health. If we don’t do it, who will?  The project team looks forward to working with AIHA members to spread awareness about health in construction. Please contact Thursa La if you are interested in initiating partnership activities. 

Annals of Occupational Hygiene: “Longitudinal Assessment of Noise Exposure in a Cohort of Construction Workers,” Table 1 (October 2011). Applied Occupational and Environmental Hygiene:  “Utilization of Health and Safety Consulting Services of the Ohio Bureau of Workers’ Compensation by Small Businesses” (November 2010). CDC: Morbidity and Mortality Weekly Report, “Heat Illness and Death Among Workers — United States, 2012–2013” (August 2014). “Climate Change: Global Temperature” (August 2018). CPWR ‒ The Center for Construction Research and Training: The Construction Chart Book (PDF, April 2013).  The Milbank Quarterly: “Economic Burden of Occupational Injury and Illness in the United States” (December 2011).