Worksite Wellness: prevention, education, awareness

Article Outline

• References
• Copyright

The workplace is a consistent and significant factor in the morbidity and mortality of men. For many occupations, danger is part of the job description. Studies of gender breakdown regarding rates of exposure to workplace hazards demonstrate an overwhelming male preponderance in workplace mortality. In the calendar year 2005, 1,097 Canadians were killed in their workplace [1]. Of these, 1069 were male workers while the remaining 28 were female workers, with a clear gender trend. The average rate of workplace deaths in that study was 30 times higher for men than women, with 97% of those killed on the job being men [1]. The rate of workplace death appears to be rising for men and falling for women [1].

There is also United States data on fatal work-related injuries by industry (Table 1), gender, age and occupation [2]. This data did not count combat deaths in its survey; if included, the military would have clearly qualified as America's most dangerous job in 2005. Traffic accidents caused fatalities for more workers than any other activity, with a total of 2,480 deaths, more than 43% of all fatal workplace occurrences. Violent acts contributed to 14% of all on-the-job fatalities, such as policemen and sheriff's patrol officers murdered while at work. The most dangerous industry in terms of total killed was construction, where 1,186 workers died. About 32% of construction workers suffered fatal falls of one story or more.

Table 1. Occupational death rate per 100,000 – United States, 2005

Source: U.S. Bureau of Labor Statistics (2005) [2].

Fishermen worked in America's most dangerous occupation in 2005, which had nearly 30 times the death rate of the average worker [2]. Fishermen often go to sea in hazardous weather conditions, working with dangerous power tools, e.g. large winches, hoists, heavy nets and cages, often on slippery, wet or icy decks in heavy seas. Loggers, the second most endangered group, must handle tremendous weights in the form of irregularly shaped tree trunks that can be very difficult to control. In addition, both fishermen and loggers may sustain injuries in remote areas far from medical help, and may therefore succumb to injuries that might not otherwise have been fatal.

It is vital to remember that job fatalities are only the tip of the iceberg in defining the spectrum of on-the-job hazards. Many non-fatal events can result in significant long-term or lifelong impairment of function and/or quality of life. Major non-fatal impairments may include sensory disability, physical disability, mental disability, disabilities that render individuals incapable of self-care or going outside the home, or employment disability.

Hazardous workplace exposures may include mechanical stressors, which are defined as being precipitated by physical acts, such as lifting, reaching, grasping, holding or moving [3]. Examples include fatigue, which may be localized or generalized. Postural stress may be caused by sitting or by stressful limb postures, e.g. raising arms above head. Vibration injury may be caused by vibrating power tools, and may include hand-arm vibration syndrome with secondary Raynaud's, pain, paresthesias, fatigue, and declining hand strength. Repetitive motion (stress) injuries, also called cumulative trauma disorders are another common type of mechanical stressor [3].

Both ionizing and non-ionizing radiation exposure hazards may exist in the workplace [3]. Ionizing radiation types include X-rays, gamma rays, and cosmic rays. In addition, particulate radiation such as alpha particles, electrons, neutrons, and protons may have ionizing effects. Many workers may be exposed, including uranium miners, reactor workers, health care workers, researchers, and manufacturers. Non-ionizing radiation types include ultraviolet (UV) light, radio frequency (RF), and extremely low frequency (ELF). RF and ELF may have thermal effects. UV-B is associated with basal and squamous cell carcinomas, melanoma, cataracts, and macular disease [3].

Thermal stressors are impacted by three factors: environmental temperature, heat generated by the worker, and the capacity for effective heat removal [3]. Heat disorders may be relatively benign, including syncope, edema, tetany, and cramps. Heat exhaustion includes salt or water depletion types. Heat stroke is characterized by the complete failure of heat dissipation mechanisms, high core temperature, CNS dysfunction, disturbances of consciousness, circulatory collapse, and hypotension [3].

Cold stressors result only from excessive, uncompensated heat loss, usually excess convective heat transfer from skin into air or water [3]. Heat loss may be systemic (heat loss exceeds heat production) or local (more common, usually involving the extremities). Effects may include chilblains, frostbite, cold urticaria, and Raynaud's phenomenon. Systemic effects may include essential hypertension, and thromboembolic disease. Dysmenorrhea may be associated with cold exposure [3].

Specific hazardous material exposures in the workplace can be delineated [3]. Asbestos is associated with pleural disease and lung cancer. Other potentially hazardous exposures include solvents, welding fumes, pesticides, metals (including lead), noise-induced hearing loss, allergic and irritant contact dermatitis, visible light injury, e.g. lasers, welding and other respiratory toxins [3].

With regard to asbestos, most exposure comes from mining, milling, manufacture, and the use or removal of asbestos products [3]. Asbestos-related diseases include pulmonary fibrosis, pleural fibrosis, pleural effusion, chronic bronchitis, respiratory (lung and laryngeal) cancers, gastrointestinal cancers, and malignant mesothelioma of the pleura, peritoneum or mediastinum. Latency to lung malignancy averages about 25 years, to mesothelioma 30–35 years. Asbestos plus cigarette smoke is highly oncogenic. The only solution is to prevent or reduce exposure [3].

Other mineral dust exposures include silica [3]. Silicosis is a pneumoconiosis characterized by fibrotic reactions to lung depositions of inhaled quartz dust. The clinical course of silicosis may include silica nodules, acute and chronic silicosis, and massive pulmonary fibrosis. There is some association of clinical course with intensity and duration of dust inhalation. Other pneumoconioses include coal and synthetic vitreous fibers manufactured from minerals. Once again, the only solution is to prevent or reduce exposure [3].

The workplace may include animal, vegetable and microbial exposures [3]. Animals and plants are particularly important in respiratory disease, e.g. chronic bronchitis, asthma, allergic alveolitis (farmer's lung), toxic pneumonitis (silo fillers's lung), rhinitis, Byssinosis (cotton), and hypersensitivity pneumonitis. Microbial diseases may be spread in the workplace, including the common cold, strep throat, influenza, tuberculosis, gastrointestinal infections, parenteral infections (human immunodeficiency virus (HIV), hepatitis B and C), and occupational zoonoses (anthrax, rabies). Primary preventions include screening, immunization, and surveillance [3].

The workplace may harbor increased hazards for men of minority groups. The overwhelming majority of workers in the 10 most hazardous jobs are men, and most occupational deaths occur among men. Men of minority groups are disproportionately represented in manual labor jobs that are physically painful and dangerous. Traditionally, some dirty, dangerous jobs were actually referred to as ‘Negro work [4].’

Creative approaches to other barriers to workplace safety will be needed. The expense of appropriate safety equipment may be prohibitive for smaller businesses. Safety equipment may interfere with comfort on the job, e.g. wearing full-body chemical protective suits in hot weather. Safety equipment may interfere with performance on the job, e.g. hearing protection in a noisy environment may prevent workers from being able to hear instructions or warnings.

The present paradigm can be reversed, with the workplace being used to help promote men's health. Health education and health screening can be provided in the workplace. Men are traditionally not well engaged in the health care system, owing in part to attitudinal and cultural barriers, such as distrust of the health care system, fatalistic attitudes (‘you’ve got to die of something anyway’) and maladaptive self-reliance (‘a ‘man’ takes care of his own problems.’) Men are typically socialized to ignore feelings of pain, fatigue, and fear, and as a result may expose themselves to hazard unnecessarily. Informational barriers exist with a pervasive general ‘lack of information’ on men's health. ‘Health care system barriers’ exist within the healthcare system, such as schedule conflicts, with many men's work hours eclipsing the hours of health care availability, as well as a pervasive lack of health programs that target males. Economic barriers are a factor for many men since men as a gender are less likely to carry health insurance.

In the United States, the Men's Health Network has pioneered health education projects in the workplace. Such activities simultaneously inform, raise awareness and advocate for men's health issues. These are often framed in the form of ‘lunch and learn’ activities – a staff luncheon is held while the lecture is in progress, and these have been conducted in a number of major U.S. corporations. The Men's Health Network has also pioneered health screening projects in the workplace in the United States. The Men's Health Network has conducted screenings in legislative settings to help convince lawmakers and their staff of the value and importance of screenings. Screenings have been conducted in more conventional work settings as well. This overcomes several barriers to men's health simultaneously, specifically work hours that eclipse health care availability hours, lack of programs that target men, and lack of information and awareness about men's health care issues.

Back to Article Outline

References 

1. Kanetix.ca. Jobs that can kill: workplace fatalities in Canada by gender. Available at: http://www.kanetix.ca/ic_life_info_life_articles_30.
   • View In Article
2. U.S. Department of Labor: Bureau of Labor Statistics. Census of fatal occupational injuries (CFOI) – current and revised data. Washington, DC: US Bureau of Labor Statistics; 2005. Available at: http://www.bls.gov/iif/oshcfoi1.htm#2005.
   • View In Article
3. Rosenstock L, Cullen MR. Textbook of Clinical Occupational and Environmental Medicine. New York: W. B. Saunders Company; 1994;
   • View In Article
4. In:  Braithwaite RL,  Taylor SE editor. Health Issues in the Black Community. 2nd Edition. San Francisco: Jossey-Bass; 2001;p. 648
   • View In Article