HEALTH ISSUES IN BUSINESS

Health issues in business are as critical in the early twenty-first century as they were in the mid-twentieth century. Many of the injuries and illnesses have changed but their impact is no less dramatic. The increased use of computers and job specialization have contributed to a new generation of occupational hazards, especially repetitive motion injuries, also known as cumulative trauma disorders. These are injuries caused by repetitive hand, arm, or finger motions that cause tendons to swell and become progressively more painful. In advanced cases, workers lose the strength in their thumb and fingers and eventually become unable to complete simple tasks, such as lifting a baby or tying their shoes. Cumulative trauma disorders were the most common type of illness reported in 1997, accounting for 64 percent of the 430,000 cases of illness reported.

FEDERAL AGENCIES

Two federal agencies are designed to operate in the occupational health and safety arena: the Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH). Both were created by the same act of the U.S. Congress in 1970; each, however, has a very distinct purpose. OSHA, which is part of the U.S. Department of Labor, is responsible

for developing and enforcing rules and regulations in regard to workplace health and safety. NIOSH, which is part of the U.S. Department of Health and Human Services, is a research agency, identifying the causes of work-related disability and injury as well as potential hazards of new technology and practices.

Historically, OSHA agents have been compensated for the number of violations they have found at job sites. This has created an environment in which citations are given for all violations regardless of how small, causing employers to fear OSHA rather than seek its help with health and safety issues. Formerly, OSHA did not promote partnerships with companies to solve health- and safety-related issues in the workplace. OSHA now offers companies a choice between a partnership or a traditional enforcement relationship.

Companies that choose to go into partnership with OSHA work with the agency to develop health and safety programs. OSHA recognizes the companies that truly commit to the new partnership by reducing or eliminating workplace hazards through a more lenient inspection policy, priority assistance, and reductions in penalties up to 100 percent. By involving both the companies and the workers, a more collaborative relationship has developed that has initiated better workplace practices and solutions to health and safety issues.

NIOSH, whose primary role is research, has developed the National Occupational Research Agenda, which identifies the top twenty-one health and safety research areas on which to focus its work through 2009 (see Table 1). The agenda was developed in collaboration with numerous stakeholders, including employers, employees, and labor organizations. Research areas were chosen based on the greatest needs and the areas most likely to produce the greatest overall gains to workers and industry as a whole. NIOSH is not able to tackle all of these alone. It must be a collaborative effort with the entire health and safety community.

LEGISLATION

Two acts passed in the 1990s have had a significant impact on people who are disabled or who have experienced serious illness. The first is the Americans with Disabilities Act, passed in July 1990. This act, which applies to employers with more than fifteen employees, prohibits discrimination against people with disabilities. Under this act, an employee is entitled to certain rights regarding employment upon returning from disability leave and proving the ability to perform the essential functions of the job. The employer is required to provide "reasonable accommodation" when necessary, that is, to change work schedules, adjust equipment, or modify tasks to enable the employee to continue to perform the job held prior to taking the disability leave. Reasonable accommodation is required except when the employer can prove that it would cause undue hardship on its part. Another option is to transfer the worker to another position within the company.

The second act is the Family and Medical Leave Act (FMLA), which was enacted in August 1993 and applies to employers with fifty or more employees. Employees who have worked for employers in this category for longer than one year are entitled to take up to twelve weeks of unpaid leave annually for certain medical or family situations, including suffering from a serious health condition themselves. The FMLA requires employers to guarantee employees who take a leave the right to return to an equivalent job—that is, the pay, benefits, and other terms and conditions of employment must be equivalent. This provides employees who are temporarily disabled with job security.

THE ROLE OF WORKERS' COMPENSATION LAWS

The original purpose of workers' compensation laws was to protect employers as well as employees in cases of occupational injury or illness. Employers were protected from lawsuits initiated by employees seeking restitution for workplace illness or injury, and employees were compensated for the cost of medical care in addition to lost wages. Currently, most private employers are required to have workers' compensation insurance, with the exception of employers in New Jersey, South Carolina, and Texas.

Workers' compensation insurance is no-fault. In other words, regardless of who is at fault (the worker, employer, or neither), the employer is responsible for compensating the worker for health care and lost wages. The employee's responsibility is to notify the employer as soon as an injury or illness occurs. Workers' compensation issues have become extremely complex because what is considered a compensable illness or injury (warranting restitution by the employer) varies considerably from state to state. The most liberal state is California, where any disease alleged to be aggravated by work-related stress could be compensable. This approach can distort statistical data and it also makes it extremely difficult to control the costs of workers' compensation insurance.

PREVENTION

Employers play a vital role in the prevention of workplace injuries and illnesses. They are responsible for evaluating workplace injuries to discover possible causes and for developing prevention strategies for those injuries. Other employer responsibilities include safety and hazard training, drug testing, workstation evaluations, and enforcement of the use of protective equipment. Employers have an array of resources from which to draw when analyzing workplace hazards and developing health and safety programs. These include industrial hygienists, certified safety professionals, federal and state OSHA programs, and NIOSH.

Ergonomics

Ergonomics also plays a significant role in the prevention of workplace injuries and illness. Ergonomics is the science of designing and arranging tools and equipment to fit workers. The overall goal is to prevent workplace illness and injuries that result from poor workstation design or improperly designed equipment.

Workstation evaluations are an example of an ergonomic program that many large companies employ. During this evaluation, a health and safety professional evaluates workers performing daily tasks at their workstations. The health and safety professional observes the workers in order to evaluate the "fit" of the workspace, furniture, and equipment to the workers.

In the case of a worker who spends the majority of the day at a computer, the professional would look at several factors to determine the degree to which the workstation fits. These factors include the height and position of the computer screen and keyboard in reference to the worker's body posture, the height and position of the worker's chair, and the types of movements the worker makes while performing tasks. From this evaluation, changes may be made to alleviate discomfort and prevent harmful injuries. These changes may include the repositioning of furniture, or in some cases, the purchase of more appropriate equipment and furniture. For example, a worker may be using a chair that does not provide the type of support the worker needs for sitting at the computer most of the day. "Standing" workstations are sometimes provided for workers who cannot sit comfortably all day, but are able to stand without discomfort.

Adding a screen shield is another example of a simple change that could drastically cut down on the amount of eye strain due to glare that a worker experiences at the computer. In addition to the evaluation, the health and safety professional gives the worker advice on how to sit, how to position hands on the keyboard, and how often to take breaks.

Early intervention is the key to preventing repetitive motion disorders such as carpal tunnel syndrome. Carpal tunnel syndrome is a condition that affects the median nerve in the wrist. Left unchecked it can cause pain, numbness, and tingling in the hand and wrist. Carpal tunnel syndrome accounts for 10 to 17 percent of repetitive motion injuries.

There are no comprehensive ergonomic standards in force in the United States as of 2006. In February 1999, OSHA proposed its first draft of ergonomics standards. Proponents believe it will help control the large numbers of musculoskeletal disorders (disorders involving both muscle and skeleton, such as back pain and neck strain). These disorders account for 34 percent of all lost workday injuries and illnesses and cost $15 billion to $20 billion annually in workers' compensation costs, according to the Bureau of Labor Statistics.

Business groups object to the federally imposed standards, saying that the standards will be a "blank check" for OSHA inspectors and will require all American businesses to become full-time experts in ergonomics. In addition, the U.S. Chamber of Commerce points out that there are currently (1) no scientifically established standards for what is "overuse" and (2) no existing studies that demonstrate the connection between ergonomic adjustments and injury prevention. While the connection does seem to make sense, it must be admitted that more studies need to be done before meaningful standards can be established.

WELLNESS AND OTHER PROGRAMS

Another way employers are helping to prevent workplace injuries and illnesses is to maintain workplace wellness programs for employees. Wellness programs may include a variety of health and fitness programs for their employees. Research has shown that in addition to health benefits for employees, wellness programs also provide financial benefits for the employer. Wellness programs help employees stay healthy by providing fitness programs, weight management classes, counseling services, and informational resources on health issues. Keeping employees healthy is one means to a profitable business. Many corporations include wellness programs as part of their overall organizational strategy.

A final critical element in the prevention of workplace injuries and illnesses is the development of health and safety programs designed to train and educate workers on workplace hazards. OSHA recommends the following elements for a comprehensive health and safety program:

• Management leadership and commitmentx
• Meaningful employee participation
• Systematic hazard identification and control
• Employee and supervisor training
• Medical management and program evaluation

CONCLUSION

The field of occupational safety and health is extremely broad and complex. The prevention of occupational injuries and illnesses has to be a collaborative effort involving employers, employees, federal and state agencies, and health and safety professionals.

see also Americans with Disabilities Act of 1990; Ergonomics; Workers' Compensation

bibliography

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Herington, Thomas N., and Morse, Linda H. (Eds.). (1995). Occupational injuries. St. Louis, MO: Mosby-Year Book.

National Occupational Research Agenda. http://www.cdc.gov/niosh/images/table1.gif

Rosenstock, Linda, and Cullen, Mark R. (1994). Textbook of clinical occupational and environmental medicine. Philadelphia: Saunders.

Sims, Miriam (1997, March 28). Wellness programs are worth every dollar you spend. St. Louis Business Journal. Retrieved November 17, 2005, from http://stlouis.bizjournals.com/stlouis/stories/1997/03/31/focus5.html

U.S. Department of Health and Human Services. National Institute for Occupational Safety and Health. http://www.cdc.gov/niosh/homepage.html

U.S. Department of Labor. Bureau of Labor Statistics. http://stats.bls.gov

U.S. Department of Labor. Occupational Safety and Health Administration. http://www.osha.gov

Brenda J. Reinsborough