National Conference to Prevent Hearing Loss in Construction:
P R O C E E D I N G S
Address: Preventing Hearing Loss in the Construction Trades: A Best Practices Conference
LINDA ROSENSTOCK, MD, MPH
National Institute for Occupational Safety and Health
To set the stage for the projects and programs discussed later, we must recognize the enormous toll that occupational injury and disease place on workers in the United States. Each day in the United States 9,000 workers sustain disabling injuries on the job, 17 workers die from work-related injuries and 137 workers die from work-related diseases.
As daunting as this seems, globally things are much worse. Recently, the International Labour Office (ILO) estimated there are 1.1 million annual work-related deaths worldwide. Global statistics reveal an estimated 3,000 deaths per day or 2 per minute, approximately 250 million work-place injuries/year and 160 million cases of work-related diseases.
When we look at occupational disease and injury in terms of cost, data from a NIOSH-funded study reveal $171 billion annually in direct and indirect costs of occupational injuries and illnesses ($145 billion for injuries and $26 billion for diseases).
These costs compare to $33 billion for AIDS, $67 billion for Alzheimer’s Disease, $164 billion for circulatory diseases, and $170 billion for cancer. Even though the annual cost for cancer in our country is the same as for workplace illness and injury, the total federal investment for worker health research is $200 million compared to nearly $3 billion for cancer. In other words, we are investing 15 times more for cancer than for worker health research.
At NIOSH, a significant portion of our research focuses on safety and health in our construction initiative. NIOSH first received Congressional funding for the construction initiative in 1990 - approximately $1 million. Currently, Congress appropriates approximately $12 million to NIOSH for construction safety and health research, although we actually spend more money on this important area. In 2000, as part 2 of our construction initiative, NIOSH allocated $17.1 million to conduct approximately 132 intramural projects and approximately 20 extramural projects in construction.
The construction industry presents many opportunities for research and intervention, in part because of the variety of its workforce. According to the Center to Protect Workers’ Rights, in 1996 the construction industry employed 7.9 million workers, of whom 2.0 million were self-employed. Women make up 2.5% of this workforce, and minorities make up 10.2%. Forty-five percent of the workforce is employed in establishments with less than 20 employees. The average age of construction workers in production occupations is 37. (BLS, 1996) Trends in construction follow overall U.S. trends, with an increasing number of female and minority workers, but overall diversity in the construction workforce lags behind the diversity of the rest of the workforce.
What isn’t captured so far in these data is the high mobility of the construction workforce. High turnover is relevant to recent findings from the Bureau of Labor Statistics which indicate that of the 1.8 million cases of illness and injury resulting in lost time from work in 1997, about one-third were suffered by those who had less than one year with their current employer, and about two-thirds were suffered by those with less than five years. This was particularly true in construction and mining.
In broader terms, NIOSH’s National Traumatic Occupational Fatality surveillance system reveals that construction workers’ fatality rates are three times higher that the national average. From 1980 - 1994 construction had a rate of 15.5 fatalities per 100,000 workers. The construction industry had the third highest rate of work related deaths behind only mining (30.5) and agriculture/forestry/fishing (20.5). In terms of absolute numbers however, construction has the largest number of work-related fatalities - 16,091
NIOSH is tackling the issue of hearing loss among workers through a number of mechanisms, including the National Occupational Research Agenda (NORA). NORA was developed in 1996 with input from over 500 organizations and individuals outside NIOSH to guide occupational safety and health research through the next decade. The agenda consists of 21 unranked research priority areas. Twenty partnership teams were 3 created for each of the priority areas (low back and musculoskeletal disorders of the upper extremity are being addressed by one team) to involve key stakeholders, define research needs, and leverage resources. Through NORA, we have demonstrated great success in increasing attention, funding, and research activities in these areas, which have implications for construction safety and health.
Virtually all of the 21 priority research areas of NORA are directly related to construction. As one of the 21 priority areas, hearing loss is linked to a number of other NORA areas, including emerging technologies, mixed exposures, organization of work, special populations at risk, control technology and personal protective equipment, exposure assessment methods, health services research, intervention effectiveness research, social and economic consequences of workplace illness and injury and surveillance research methods.
The NORA hearing loss team is in the process of finalizing a White Paper, developing a model curriculum for professional training on hearing conservation, and sponsoring best practices conferences in hearing loss prevention – the first held in Detroit in October 1999 and this being the second.
One of our most exciting hearing loss and construction projects has been funded through the NORA process, and is being conducted by members of our NORA team. In 1995 and 1996, through NIOSH’s Health Hazard Evaluation program, NIOSH researchers conducted a series of 600 audiograms on members of the International Brotherhood of Carpenter’s Union. The results demonstrated that permanent hearing loss begins early in a carpenter’s career, and continues to worsen. For example, at 25 years of age, apprentices had lost as much hearing as an average 50 year old man.
By age 50, the hearing impairment among carpenters is so severe that by the time the average carpenter is between 50 to 55 years of age, two out of three will need hearing aids. On the basis of these findings, the International Brotherhood of Carpenter’s Union invited our researchers to work with them. Through that effort, to date the researchers have completed a series of task-based exposure assessments to evaluate the noise levels associated with a variety of tasks in commercial and residential carpentry. A video for apprentice carpenters about preventing hearing loss has also been developed. The script 4 for the video was based on behavioral research on the barriers to wearing hearing protection, and is currently included as part of a training curriculum for apprentices.
The success of this program continues. In fiscal year 2000, we have provided additional NORA hearing loss funds to support the evaluation of the previously created curriculum, to develop a second video on the correct fitting of hearing protectors, and to continue to refine the use of optical card technology. Optical card technology is an interesting approach to dealing with a mobile workforce, for it allows workers to carry their health and safety data with them to whatever job site they’re working at.
Another example of hearing loss research at NIOSH is a cooperative research agreement with, among others, the Ford Motor Company and the United Auto Workers. NIOSH and its partners in research are developing a new information management system to help prevent hearing loss. The system is designed to run on a desktop PC. This has particular relevance to the construction industry in that individual worker data, which can be stored on an optical card, can be carried by the individual worker and then entered into the PC based system at his/her next worksite. The management system, referred to as HearSaf 2000 is expected to be available this spring.
While new NORA hearing loss research is exciting, NIOSH has a long history of working in this area. Unfortunately, however, hearing loss research has suffered within NIOSH because of budget constraints, particularly in the engineering controls area. In a reorganization recently completed in Cincinnati we are bringing together the engineering, control technology and noise groups under the Engineering and Physical Hazards Branch of the new Division of Applied Research and Technology. We expect that this alignment will enhance NIOSH’s ability to control noise through engineering controls and better position the Institute to conduct noise research overall.
Additionally, NIOSH is integrating its noise resources by developing an interdivisional and interdisciplinary Noise Steering Committee. This new committee will be patterned after the agriculture and the construction steering committees that NIOSH has had in place for a number of years to guide intramural and extramural research in these areas.
The creation of the noise control branch at our Pittsburgh Research Laboratory is also greatly enhancing our engineering control capabilities. The Pittsburgh Research Lab 5 (PRL) is the in process of revisiting research once done in the mining environment, in an effort to determine what is still applicable and where we can do more. This research is relevant to construction because of the similarities in equipment such as bulldozers, drills and load-haul dumps. It is also important in light of our construction, agriculture, and mining program initiative, which is a new focus within NIOSH to gain synergy among researchers who investigate similar problems in different occupational sectors.
PRL’s mobile testing laboratory, which travels by van and happens to be here today, allows NIOSH researchers to conduct hearing tests, fit personal hearing protection, demonstrate an individual’s level of hearing loss, and simulate future loss via a multimedia computer program.
The last area I’m going to talk about this morning is partnerships, for in addition to increased collaboration internally on hearing loss, NIOSH has been collaborating with best practices conferences, publishing new documents with the National Safety Council (NSC), and a national noise-induced hearing loss prevention campaign.
On October 28, 1999, 150 leaders from industry, government, labor, the professional community and academia met in Detroit to share proven strategies and new advancements for protecting workers’ hearing. The sponsors included NIOSH, the National Hearing Conservation Association, and the Occupational and Environmental Health Sciences Department of Wayne State University. Additional conference supporters included the Michigan Occupational Safety and Health Administration, the Michigan Industrial Hygiene Society, the American Industrial Hygiene Association, the National Safety Council, the Institute of Noise Control Engineering, and the Douglas A. Fraser Center for Workplace Issues. A conference summary document is in development and will soon be available in printed form and on the NIOSH web site.
NIOSH has also collaborated with the National Safety Council to produce issuesof Today’s Supervisor and Safe Worker dedicated to the topic of hearing loss prevention. This is the first time that NSC has devoted an entire issue to one topic and marks a new era of partnership between the two organizations.
Today’s Supervisor is targeted to supervisors and provides practical information in an easy-to-use format. This document will be distributed through NSC channels to 95,000 supervisors. The second document, Safe Worker, is written for non-supervisory personnel and is distributed to over 42,000 workers employed at NSC member companies. The documents are often included in employees’ paychecks. Copies of each document are available on the NIOSH web site.
The final partnership activity I’ll highlight is the collaboration with the National Institute on Deafness and Other Communication Disorders (NIDCD) on the Wise Ears Campaign. NIOSH joined NIDCD in launching the information campaign just before the 4th of July 1999. Through a satellite media tour, roughly eight million Americans learned about the Wise Ears effort. Thousands read about noise-induced hearing loss in newspaper coverage of the campaign. The coalition created through the campaign now has over 50 members all dedicated to eliminating noise-induced hearing loss. As part of the campaign, NIOSH also created a noise website, compiling all of the information we have on noise and hearing loss, highlighting new products, and linking to other relevant sites.
Protecting construction workers’ hearing is a challenging task. NIOSH has a demonstrated commitment to research to find ways to make that task easier, but the government alone can’t create the national sense of urgency required to adequately address this significant public health problem. Working together we can promote safe and healthy work practices to protect construction workers and their hearing.