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National Conference to Prevent Hearing Loss in Construction:

P R O C E E D I N G S

MARGARET ROBERTS

Head of Hearing Conservation Unit
Workers’ Compensation Board in British Columbia

Hearing Conservation Programs for Construction in British Columbia - A Success Story

MR. FOWLER: [In progress] -- that would intuitively tell you from their own experiences, and yet to get changes made in systems, to get equipment changes made, to get work practices changed, you need the statistics to show that it is not just one or two people saying it, but that in reality it is something that affects a whole lot of people. I think, in fact, to get changes made, you also have to show oftentimes that there is an economic impact to this whole thing. It is not just enough to have a Bill Duke stand here and tell you what the personal impact of it is, but that there is an economic impact and those are the kinds of things that I think that the expertise that you bring and the research that you bring enables

At the Health & Safety Fund, we have been looking at a lot of these things for quite a few years now. For instance, Dr. Suter was talking about the medical records and how to do that by computer or by a chip. We have been looking at that, and we have made some progress there. We are hoping that we will have a system in the next couple of >years that enables us to do that. A lot of things she was talking about on the work zone, we have been working on that as well. So we are making progress. We are hoping to make more progress, and we hope you will join us in that. That is one of the reasons for this conference.

I would also like to point out that outside the hall here, we have a couple of vendors who were involved in hearing protection and manufacturing devices to help with that. So I would encourage you to stop by and talk to those folks and see the things that they have to improve situations on the work site.

Dr. Suter alluded several times to what is going on in British Columbia, and when we talk about hearing in the construction industry unfortunately the statistics tend to be pretty discouraging. Our next speaker brings a message of optimism, a success story. Margaret Roberts manages the Hearing Conservation Section and Audiology Unit at the Workers' Conservation Board of British Columbia Canada. She has been active in the field of occupational audiology for over 20 years. She has a master's degree in audiology and has experience with health and safety regulations as a member of the Canadian Standards Association Hearing Protection Committee, and the American National Standards Institute's working group on hearing conservation program effectiveness. She is also an active member of the Canadian Association of Speech Language Pathologists and Audiologists and the National Hearing Conservation Association. So she brings a great deal of expertise, but I think she also brings the practical effects of a program.

The story she will share with us demonstrates that hearing conservation efforts, properly implemented and enforced, can reduce both the incidence of hearing loss and the degree of the severity of those hearing losses.

Margaret, we thank you for coming so far to be with us, and we look forward to your success story.

MS. ROBERTS: Thank you, Joe and Scott, for inviting me.

I really am delighted to be here to share our experience with you, and certainly after having heard Mr. Duke this morning, those kind of talks always energize me and really reinforce why it is we are making such great efforts to bring some awareness to the life experience that this disability can have.

I hope by hearing some of our strategies, you will hopefully avoid some of the roadblocks that we have had dealing with this a very challenging issue, in this even more challenging industry. I think that it certainly is worth pursuing.

Just a bit of background, about the Workers' Compensation Board, because I think our structure has enabled us to do some things that are clearly more challenging in other situations. In B.C., we are responsible not only for the no-fault insurance company, covering occupational accident and disease claims, but also for the health and safety regulations, the development, the implementation, and the enforcement of these regulations.

The concept of "funded by industry" was mentioned earlier. That is a very important aspect of how we were able to achieve hearing testing in this industry. Our business is totally funded by an assessment on industry. Depending on how hazardous you are and how much effort is required in terms of enforcement and inspection and how costly your claims are, then the more you pay to the WCB.

In 1975, we had an economic incentive to look at hearing conservation in all of industry because that year hearing loss was added to the list of industrial diseases for which you could get compensation because you had the industrial disease. Prior to that, you could only claim for benefits if you had wage losses, and by and workers in noisy occupations are able to continue doing their jobs.

So, in 1975, we had a potential for a quarter-of-a-million noise exposed workers filing claims. We were looking at both permanent partial disability awards and hearing aids. I am here to tell you that after 20 years, it is the hearing aids that are the costly part of this program.

The permanent partial disability award one receives is very minimal compared to the disability, in my opinion. The hearing aids for life for something like 30,000 currently active claims is costing us over $10 million a year. That cost is not going to go away quickly because any claimant now at 55 years of age is going to be a cost to our system for another 20 or 30 years.

We had a growing economic liability, and by 1979 there was also a very clear awareness of the impact of hearing loss and the increasing understanding that this industrial disease, though painless progressive, and permanent, is totally preventable. The Board at that time spent a lot of resources on the radio and newspaper ads communicating that this was going to be a focus over the next little while.

Currently, our Board is looking at environmental tobacco smoke, and the panic that we have seen in the workplace over "My goodness, they are going to bring in these kind of regulations," I just sit there and say, "Well, I think I remember that." Twenty years ago, there was panic when people started to talk about doing something about noise.

The claims cost impact led to our first regulations in 1979. We had very gradual compliance and enforcement. First we focused on the forest industry. It was highly unionized and they were a group that had been pushing the Board for years to look at this issue. It was not until sometime later that we really looked at the construction industry.

By 1984, it was clear to us that although these regulations applied to all industries in the Province, the construction industry was blatantly disregarding them. We began by responding to the perception that noise was not a problem in this industry, and then to the claim that even if it was, the industry should be exempt. After many discussions with the industry, the Board took some very specific actions.

First we went out and did a number of noise surveys and clearly demonstrated that noise was an issue in this industry. We also did some focussed hearing testing. We compiled a small body of information that demonstrated that these workers, like every other noise-exposed worker in the Province, did have hearing losses. We also increased our inspection attention on work sites mostly to bring some awareness to the work site.

I have to say that our inspectors at that time were also of the opinion that they had more important things to do than to consider noise. So it was within our own organization, as well as industry, that we had to bring some more awareness.

After we had all of this body of data, it did look as though the one aspect that seemed to be the most challenging to this industry was the annual hearing test requirement, and it seemed that people got so tunneled on that aspect of hearing conservation that they could not look beyond that and see that they could take some smaller steps in terms of hearing protection and education. The hearing testing aspect became very, very problematic.

Some of the issues that Alice mentioned, particularly about the mobile work force, were very challenging. For example, did annual hearing testing by each employer of a worker mean that he would need a number of tests if he changed employers? This question became a problem, and in the end, the Board decided that because we had a structure to access industry for the cost of some programs, we could intervene on the payment aspect in order to get some testing done.

So what the Board became was the group in the middle of the employer who had the ultimate responsibility for health and safety on the work site and the test provider who is in the business of providing that service to industry. We did emphasize that it is the employer's responsibility to arrange for the tests to be done. That scheduling is being done in a variety of ways. Some of the unionized groups have hearing test sites at the dispatch area so workers can get their hearing tested there. Other employers make arrangements for the mobile companies to come around to the site periodically. If it is a high-rise project, then they will come around once a week or so and test who is then on the site.

Because we also have a central repository for all the hearing test data we also have an ability to count and determine how much testing actually belongs to the construction industry. We pay the hearing test provider directly and assess the employers as a group in the construction subclass at the end of the year for the testing. The providers are doing the same thing as they do for every other firm or industry that they test, except for this group, they get paid by us.

Currently, we are paying 22.50 a test, Canadian dollars. The test, though, and this is important to us, is not just the pure tone thresholds. It includes some medical history information and the individual private counseling of that individual at the time of his test, not only about the results, that “this is you, this is your ears, what is happening with you and hearing protection,” but also the issuing of an individual record card that Alice was alluding to.

I cannot emphasize enough that there is no point in doing hearing testing for hearing testing’s sake. If the individual does not know the results, the teachable moment of taking responsibility for one’s own hearing is missed. Also, there is no point in testing year after year after year after year if something is not being done about the change that may be happening from year to year. The test record card is for the worker to keep so that next year, wherever he is being tested, the technician can look at the result this year and compare the results and provide feedback to the worker.

On a broader note, our database gives us information about how we are doing by industry and occupation. As far as the individual is concerned, there is no point in doing a test time after time after time if there is not something done about any ongoing hearing charges. We feel very strongly about counselling requirement.

To digress a little bit from the construction industry over the years we have redone our whole health and safety regulation around noise and hearing conservation with particular emphasis on “program.” In our jurisdiction as well as so many others, I think, “hearing testing” became “hearing conservation.” Hearing testing alone is not hearing conservation. Hearing testing is one element and is a measure of how well noise control, hearing protection and education are working to protect the workers.

First from a program point of view we need to know what the exposures are and to implement as much noise control as is, we use the word, “practicable”. This means if it costs too much money, you probably do not have to do it. Education and training is next, and for us includes counseling after the test. Other program elements are posting of the hazard, hearing protection, hearing tests, and program review. Program review should address information around the summary of the hearing test results.

So I would just like to talk about some of the other elements in our program because, again, I think that we are known for the fact that we have this database and we have hearing testing happening, but it is important to really look at the whole thing. My one message to you, as you are seeking some solutions here, is to ensure that whatever you are going to draft addresses all of these elements.

Initially, we obtained a lot of noise exposure information and from time to time, we are updating our database.

As far as noise control is concerned, we did a study last summer on the noise emissions from some specific pieces of equipment. This is hot off the press in the last couple of weeks, and hopefully, Scott, you may be able to use this in one of your sessions these 2 days.

With regard to the provision and enforcement of the use of hearing protection, in 1981, we had the admitted use of no protection in 50 percent. This is now (1999 figures) 16%. By and large, the type of hearing protection is an earplug, usually one of the disposable type or one of the moldable earplugs. We also see more and more use of the flat attenuation type of protection that you have heard about.

Posting of the hazard is always a strange one to me. We did a mini audit of some sites last year, and virtually none had a sign that said “this is a noise hazard” area. Whereas, every one of them had “this is a hard hat” area. To me, that is a very clear message from the site that it is not important.

As far as program review is concerned, I would say there is little done at an individual firm level.

So, have we had some success? We do know that hearing testing is being done. We did 46,000 in the construction industry in 1999. There is increased awareness. Employers know about the program, but it is my impression that the payment scheme is what is important to the employers, and there is little or no buy-in, actually, on the site. I consider the posting of the hazard and some of the program review issues to be related to that. I think that we may have done too much for employers instead of getting complete buy-in from all parties.

The best measure of our success is the reduction of the incidence and degree of hearing loss. This is an audiogram. Across the top are represented the different tones that we test in hearing, from low frequency, 500 hertz, up to 8,000 hertz. Down the side is how loud the sound had to get in decibels before the individual heard. This is population data for heavy equipment operators. These were workers who had been in the industry for 26 years in 2 population groups, 1989 and 1999. The average hearing level for workers in 1989 that had been in the industry for 26 years is in the red graph, and 1999 is in the blue. 1999 results are significantly better than those for 1998. Carpenters also show better hearing now compared to 1989.

Our data show that we have had some success in reducing the incidence and degree of hearing loss. Our claims cost for new claims are reduced, compared to 10 years ago in this industry. Our ongoing costs for this industry however are enormous as we move forward with hearing aids, but we think that we have made a difference. We are concerned that there is not the buy-in on site for some of the other activities around hearing conservation, but I think that from the discussions that we have with claimants, claimants and more and more willing to talk to their colleagues on site about why, like Mr. Duke said this morning, “you do not want to end up like me with this hearing loss.”

I encourage you to pursue this direction. I just cannot say it better than Mr. Duke said this morning. We have the benefit in our organization to work with claimants and work with hearing conservation, and if you ever lose your zeal for this issue, you just have to assess a few claimants and your enthusiasm is right back because it is a lonely life for these workers, and it is something that they do want us to do something about.

Thank you.

[Applause.]

MR. FOWLER: Thank you very much, Margaret. We appreciate the remarks and the somewhat optimism, obviously not ready to declare victory, but we appreciate seeing progress and hope we can make some progress as well.

We are a little bit ahead of schedule. So I am going to remind you again that we do have the NIOSH van outside, if you want to take advantage of that. Get those cell phones out and make all of those phone calls, probably contribute to hearing loss as well.

The luncheon will start at 11:45 upstairs in the Atrium Ballroom above us.

I also want to just take a second before we break here to acknowledge and thank not just the co-sponsors of the conference here, NIOSH and OSHA, but the folks who have helped us out by sponsoring the breaks and the continental breakfast and the luncheon. The New England Health and Safety Fund, with Bob Moretti, right here, thank you very much. The New York Health and Safety Fund, Jim Melius in the back of the room there, thank you, Jim. The New Jersey Health and Safety Fund, Rob Lewandowski back there, thank you. The Industrial Safety Equipment Association right here, thank you very much. The St. Paul Insurance Company, even though they have been

badmouthed already, but Don will be speaking to you at the workshop and tomorrow, we appreciate your support for this, and they have been very supportive. The Construction Industry Manufacturers Association, thank you very much, and the American Road and Transportation Builders Association, back in the back there. We thank you all very much. We could not have done this without you, and we appreciate your support for this.

We will break now. This afternoon is an exercise in logistics as well. You have got to look at your badge and see what your color is, and then follow your scheme through the workshops. That is going to tax everybody.

Enjoy the lunch. We will see you up there in a few minutes.

[Luncheon recess.]