Section Chair’s Column

Section Awards nomination form

Update on Ergonomics

Book review - The Chair: Rethinking Culture, Body, and Design

The Global Economy and Safety, Health and Environmental Standards: Changing AIHA and ACGIH policy

Scholarship update - Send money!

Review of Studies on Work Stress

Concerns about APHA Corporate Sponsorships policy

Next newsletter deadline

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From the Section Chair - Tom Robins

Our section’s influence continues to be felt throughout the organization and nationally. During the past year, three of our section members have moved into nationally prominent positions. Jordan Barab is Special Assistant to the Assistant Secretary of Labor (head of OSHA). David Michaels is the Assistant Secretary, for Environment, Safety and Health, U.S. Department Of Energy. Andrea Taylor is a member of the new U.S. Chemical Safety and Hazard Investigation Board. Within APHA, Howie Frumkin continues as Chair of the Science Board. Our section has nominated three members for association wide positions or awards. Peter Orris has been nominated for a position on the Executive Board, Stephen Zoloth has been nominated for a position on the Science Board, and June Fisher has been nominated for the 1999 APHA Award for Excellence. Will keep you posted on the results of these nominations.

Our section and its members are contributing substantially to the critical fight for an OSHA ergonomics standard (see related article in this newsletter). We worked behind the scenes to ensure that Charles Jeffress, the Assistant Secretary of Labor for OSHA, had a letter of support from APHA in hand when he announced in February OSHA's decision to issue a proposed ergonomics rule this summer. Our membership, led by section councilor Deborah Weinstock, is spearheading a lobbying campaign to defeat the congressional bill, HR 987, introduced by Rep. Blunt which would require the completion of yet another National Academy of Science study before OSHA could begin work on the standard.

An important ongoing activity of our section, working together with the Labor Caucus, is to influence APHA to choose unionized hotels whenever possible for meetings as well as union labor for construction projects. At this past Annual Meeting in Washington, DC, much to our disappointment, our own section was located in a non-union hotel. Since then, OHS section member Peter Orris worked closely with Valerie Wilk of the Labor Caucus to submit a resolution concerning the use of union hotels. This resolution, along with others submitted by our section, will be voted on at the annual meeting in November in Chicago. We have also received assurances from APHA staff that the section will be in a union hotel this November.

In addition to the joint resolution concerning the use of unionized hotels at the APHA annual conference described above, our section submitted two additional resolutions. The first titled "Preventing Transmission of HIV, Hepatitis B., Hepatitis C and Other Blood-borne Pathogens by Mandating Safer Medical Devices" was submitted by our resolutions committee chair Jim Cone and section member June Fisher. The second, titled "Preventing Environmental and Occupational Health Effects of Diesel Exhaust" was submitted by Jim Cone and by David Raglund. Resolutions are important. Once a resolution is passed it essentially becomes part of APHA policy, the weight of the organization can be called upon when needed in support of the issue addressed by the resolution. For example, it was because APHA had adopted in 1995 a resolution on ergonomics put forward by our section, that the organization was able to play a leading role in supporting OSHA’s standard setting efforts this year. We can use the policies in our local settings as well as on the national level to fight for better working conditions.

Led by Secretary-Elect Craig Slatin, our section has played a leading role in raising questions about the current direction of APHA's corporate relations. Please see the accompanying letter on this authored by Craig and submitted by our section to the Executive Director and Executive Board of APHA as well as distributed to the Intersectional Council (which has representation of the leadership of all of the APHA sections). A number of chairs of other sections have sent messages sympathetic to the position presented in this letter. We have also requested that this be an item of discussion at the midyear Intersectional Council meeting to be held in June. Consideration is being given to late breaking resolutions and other approaches to addressing this issue within the association.

No doubt most section members are aware that the Executive Board of APHA recently selected Mary Northridge as the new Editor of the association’s journal, the American Journal of Public Health. However, many members may not be aware that there is a great deal of controversy surrounding the procedures followed by the Executive Board and the Executive Director of APHA in this selection process. In fact, Wendy K. Mariner, who was the Chair of the APHA Editor Search Committee and the journal’s Editor of Health Law and Ethics, resigned her position in protest against actions which she stated in her resignation letter "have undermined the independence of the editor’s position and the journal itself." A number of current and former members of our section leadership also took exception to this process. Our section leadership has taken a position of advocating further discussion and debate about this process, particularly as regards the independence of the editorship of AJPH. It should be understood that the concerns here are focused entirely on the process and the independence of the position of editor, and are not about the specific choice of Dr. Northridge as the new editor.

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The Occupational Health and Safety Section has three awards:

• The Alice Hamilton Award recognizes the life-long contributions of individuals who have distinguished themselves through a career of hard work and dedication to improve the lives of workers. Denny Dobbin was last year’s winner.

• The Lorin Kerr Award recognizes a new activist for their sustained and outstanding efforts and dedication to improve the lives of workers. Garrett Brown was last year’s winner.

• The International award recognizes individuals with outstanding achievement in the field of occupational safety and health outside the United States. Rory O'Neil (England) and Mohamed Jeebhay (South Africa) were last year's winners.

A list of award recipients from past several years is on our section web site. You can reach it through the APHA web site or directly at http://staff.washington.edu/oshalert

The Occupational Health and Safety Section is soliciting nominations for all three of these awards. To nominate someone, Please provide the following information

Name

Proposed Award (Circle One) Alice Hamilton Lorin Kerr International

Please explain the work the nominee has done which has caused you to nominate them for an award. Don’t assume we know your nominee and their efforts and achievements. Brevity is a virtue, also.

Reason for Nomination:

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Please submit nominations to Darius Sivin at Email: dsivin@jhsph.edu

Address: 1900 S St NW #303 Washington DC 20009

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By Jackie Nowell and Deborah Weinstock

In February, with publication of a draft regulatory text, OSHA began the lengthy process of promulgating an ergonomics standard. The standard will address the epidemic of musculoskeletal disorders (MSDs) that’s occurring in US workplaces. According to OSHA statistics, more than 647,000 Americans suffer MSDs each year, accounting for 34% of all lost work day injury and illnesses and costing $15 - 20 billion annually in direct workers compensation costs. While many companies have effective ergonomic programs, many more do not, leaving millions of workers unprotected. A standard is also needed to provide OSHA with the tools, the regulatory basis, to inspect and cite when necessary employers who are exposing their employees to risk factors that cause MSDs.

This standard is long overdue. The Department of Labor first made the decision to develop an ergonomics rule in 1990, under the leadership of a Republican appointee, Secretary Elizabeth Dole. She also issued guidelines for the meat industry and OSHA provided training and consultation for companies. Unions first petitioned for an Emergency Temporary Standard on ergonomic hazards in 1991. In 1992, the rulemaking process was initiated with publication of an Advanced Notice of Proposed Rulemaking in the Federal Register. In 1995, a draft of OSHA’s proposal caused such pressure from Congress and industry groups that OSHA found it impossible to publish a standard.

The draft standard is written in plain language focused around six basic elements of an ergonomics program: Management Leadership and Employee Participation; Hazard Identification & Information; Job Hazard Analysis & Control; Training; Medical Management; and Program Evaluation.

As it is currently written, the standard covers only general industry and EXCLUDES construction, maritime and agriculture. Within general industry, the standard covers workplaces with production jobs in manufacturing operations or jobs in manual handling operations which are routine and require substantial effort. For all other jobs within general industry, coverage under the standard would only apply when a work-related MSD has been reported. This is a problem because there is not action required to prevent ergonomics injuries because the standard is only triggered AFTER workers are injured. The standard would also allow employers to apply the ergonomics program to cover some workers in a workplace and not others, even when ergonomic hazards are present for everyone. A good example is meat cutters in the back of a grocery store, who would automatically be covered, and cashiers in the front of the store who would not.

In addition, workers who have an MSD are to be provided with effective medical management, including referral to a health care professional (HCP) for evaluation and treatment. If the worker is given work restrictions by the HCP, the employer is required to adhere to the work restrictions during the recovery period and workers must continue to receive their total normal earnings, seniority, rights and other benefits during the recovery period or until effective measures are implemented to control hazards up to a maximum of 6 months.

For a summary of the proposed draft, see the AFL-CIO web page at http://www.aflcio.org For the complete draft text, see the OSHA web page http://www.osha.gov

Process for a Final Standard

The February draft was required to be reviewed for its economic impact on small businesses under the Small Business Regulatory Enforcement and Fairness Act (SBREFA) of 1996. A SBREFA panel consisted of officials from OSHA, the Small Business Administration (SBA) and the Office of Management and Budget (OMB). The panel’s report was issued to Assistant Secretary of OSHA, Charles Jeffress on April 30. The report summarizes the concerns that the 20 small entity representatives have with the draft proposed standard. The concerns range from the trigger being used to the Medical Removal Protection provision in the draft. The draft proposed standard will be revised and sent to OMB in late May or June. OMB will have 90 days to review the draft proposal. OSHA will again revise the draft and it is expected to be ready for publication in September 1999. The public will have 90 days to comment on the standard. Hearings are expected to be held in January and February 2000. OSHA will review the written and oral comments, incorporating those thought to be necessary and revise the proposal and send it back to OMB for final approval. Publication of a final standard is expected in January 2001.

This standard has been subject to politics since its inception. Politics killed the first draft. The same politics are at work in this Congress. Ever since 1990 when this rule was first under development, it has been opposed by some employer groups and conservative members of Congress, who in FY 1996 and 1998 succeeded in blocking the ergonomics standard through riders on the OSHA funding bill. In FY 1999, Congress authorized funds for a study by the National Academy of Sciences on the scientific evidence on ergonomics, but allowed OSHA to move forward with the development and issuance of a standard. Now opponents are trying once again to block the standard, and have introduced legislation to prohibit the issuance of the standard for several years until the current NAS study is completed. Their argument is that there is not enough science to link musculoskeletal injuries to the workplace. However, a large body of scientific evidence shows that workplace factors cause musculoskeletal disorders and that these injuries can be prevented.

• A 1998 National Academy of Sciences study and report, Work-Related Musculoskeletal Disorders, that found that workers exposed to ergonomic hazards have a higher level of pain, injury and disability; that there is a strong biological basis for these injuries; and that there are interventions to prevent these injuries.

• A 1997 critical review by NIOSH of more than 600 epidemiological studies on musculoskeletal disorders which reached similar conclusions as the NAS study.

• More than 2000 articles in the scientific literature on musculoskeletal disorders and workplace factors.

On March 4, Rep. Blunt (R-MO) introduced H.R. 987, legislation that would require the Secretary of Labor to wait for completion of the National Academy of Sciences study before promulgating a standard or guidelines on ergonomics. When HR 987 was introduced on March 4 it had 21 co-sponsors. By April 28, the bill had 115 co-sponsors, 11 of whom are Democrats. One of the original co-sponsors, Rep. Martinez (D-CA) has since withdrawn form the bill. The bill states that both the 1997 NIOSH study and the 1998 NAS study found insufficient evidence to assess the level of risk to workers from repetitive motions.

Though it is unlikely that H.R. 987 will make it to the House floor for a vote, it is expected that similar language will be attached as a rider to an appropriations bill. This process is likely to happen during June or July, 1999.

Action:

So, we need to get into action if we’re going to see an OSHA standard in the next millennium! Here’s some things you can do now to get into the act:

1. Write to your member of Congress. Express your strong support for a standard, one that will protect all workers from developing one of these potentially crippling disorders. A sample letter to Congress is available on the AFL-CIO web page, http://www.aflcio.org
2. Gather success stories. Send examples of successful ergonomics programs to the AFL-CIO.
3. Plan to submit written comments and testify at the OSHA hearings.

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The Chair: Rethinking Culture, Body, and Design by Galen Cranz, 1998, 288 pages, W. W. Norton and Company, New York, ISBN 0-393-04655-9, $27.50.

This book was written by an individual outside the occupational health mainstream and gave me an entirely fresh perspective on our field. Ms. Cranz, a professor of architecture at U.C. Berkeley, specializes in the sociology of architecture. She is also a certified teacher of the Alexander Technique, a modality which focuses on the interactions of posture, movement, emotion, self-concept, and cultural values. She has turned her attention to the chair at home, school, and work. The results of her research are a fascinating look at why we sit and what we sit on. She covers the history of the chair, revealing its role in defining status and class. Ms. Cranz has strong opinions about what constitutes a good or bad chair and gives plenty of illustrated examples, covering everything from La-Z-Boy recliners, to kneeling chairs, to airplane seats to ergonomic office chairs. One message of the book is that ergonomic furniture cannot solve the problem of too much sitting and inactivity because it succeeds too well in supporting the body in one, right-angled seated position. Ms Cranz knows her chairs and the book has 85 illustrations including a computer workstation without a desk that allows the individual to work while reclined with full back and head support. Ms Cranz does not hesitate to pronounce sitting at length in a chair a health hazard which compresses the spine and internal organs and deforms the body. She argues that walking should be integrated into office life for our mental as well as physical well-being. Ms. Cranz states, "The less variability you have in your job itself, the more adjustability you should have in your seating and other equipment." She also engages in an interesting discussion of the meaning of "comfort" and how it can be measured. I heard Ms. Cranz interviewed on public radio; except for this chance event, I would probably never been aware of her book. Yet the information she gives, which is essentially about substitution as the best form of control technology, has influenced me immensely in thinking "outside the box" about office ergonomics. I particularly enjoyed Ms. Cranz’s closing 4-page description of her ideal office workplace with many postural options: sitting with and without back support, standing up, lying down, reclining, kneeling, perching, leaning, squatting, and sitting cross-legged. The book is a well-referenced, well-indexed, and worthwhile addition to the library of any occupational health professional, office worker, or anyone who sits on a chair.

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By Jim Albers

Progressive members of the American Industrial Hygiene Association (AIHA) and American Conference of Governmental Industrial Hygienists (ACGIH) have organized a campaign to persuade both organizations to advocate strong occupational and environmental health protections in the emerging global economy. The campaign was initiated when members were asked to support a statement titled "Strengthening OEH&S Protections in the Global Environment." During the American Industrial Hygiene Conference and Exposition (AIHC&E) in Toronto (June 6-11), supporters will meet to discuss requesting an AIHA mail referendum on the statement and running like-minded candidates to the board.

The campaign has collected nearly one-hundred signatures from active AIHA and ACGIH members. In the statement, each organization is urged to support the upward harmonization of OEH&S standards in industrializing countries and to oppose the degradation of current standards in the industrial economies. With increasing frequency, transnational corporations have used provisions of trade and investment treaties, like NAFTA & GATT, to initiate lawsuits against sovereign states claiming that their OEH&S laws and/or regulations unfairly restrict trade. The suits usually ask for monetary damages and the revocation of the regulation. On the horizon there is the Multilateral Agreement on Investment (MAI) proposed by the World Trade Organization, which would further empower transnational corporations to meddle in the affairs of sovereign states. (Visit the Global Trade Watch/Public Citizen web page for more information about these lawsuits.)

The AIHA and the ACGIH both adopt positions pertaining to public policies and legislative initiatives, though the AIHA has been the much most active in this area. Progressive AIHA members have disagreed with the AIHA Executive Board's support for various Republican- sponsored legislative proposals intended to weaken workers' protections and OSHA.

The AIHA has opposed some of the more egregious provisions in these bills. Unfortunately, this opposition is not a part of the AIHA testimony before the Congress. AIHA representatives only speak about the provisions that they support. Aaron Trippler, Director of the AIHA Government Affairs, has said this selective testimony was necessary as the Republican majority insisted that only supportive testimony be given before the subcommittees.

Our next activities depend on the outcome of the Toronto meeting we have called to discuss the statement. The AIHA is providing the meeting room (Dockside #2) in the Westin Harbour Castle Hotel on Tuesday, June 8 between 5 pm and 7 pm. AIHA members who initiated the campaign will propose that we collect the necessary 200 member signatures required to request a mail ballot referendum on these issues. There is also interest in supporting a slate of candidates who will endorse the referendum.

Contact Jim Albers at jimalbers@fuse.net or 513-681-4995, if you want a copy of the statement or more information about the campaign.

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405 W. Redwood, 2nd Floor

For questions email Janie Gordon at jgordon@umppa1.ab.umd.edu

The Section now has an adjunct Career Book committee with representatives from the Minority Recruitment and Membership committees. We're developing a plan for using and distributing the booklet to get students, and specifically minority students, interested in our work. If you would like to join the committee, have some ideas to share, or would like to have booklets for a recruitment activity please contact Janie Gordon. jgordon@umppa1.ab.umd.edu

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By Paul Landsbergis

Several members of the APHA Occupational Health and Safety section participated in a panel on the impact of lean production and other new systems of work organization on worker health, particularly their impact on stress, on musculoskeletal disorders and on needlestick injuries. The panel was part of a conference on work stress sponsored by NIOSH and the American Psychological Association on March 11-13, 1999, in Baltimore. Several of these presentations are summarized in a discussion in the latest issue of New Solutions.

Landsbergis P, Adler P, Babson S, Johnson J, Kaminski M, Lessin N, MacDuffie J, Nishiyama, K, Parker S, Richardson C. Lean production and worker health A discussion. New Solutions 1998;8(4)499-52

In addition, a review article on this topic has recently been published Landsbergis P, Cahill J, Schnall P. The impact of lean production and related new systems of work organization on worker health. Journal of Occupational Health Psychology 1999;4(2)108-130.

The review states: "New systems of work organization have been introduced by employers throughout the industrialized world in order to improve productivity, quality and profitability. Such efforts have taken a variety of forms and names, including lean production, total quality management, team concept, cellular or modular manufacturing, re-engineering, high performance work organizations, and patient-focused care. However, a limited number of studies have examined the impact of such new work systems on occupational injuries or illnesses, or on job characteristics related to 'job strain', which has been linked to hypertension and cardiovascular disease." The studies reviewed were conducted mainly in the auto industry, but studies in other manufacturing industries and in the health care industry are also included.

The auto industry studies reviewed "provide little evidence" to support the hypothesis that lean production "empowers" auto workers. In fact, it appears that lean production creates intensified work pace and demands. Increases in decision authority and skill levels are modest and/or temporary, while decision latitude typically remains low. Thus, such work can be considered to have "job strain". In jobs with ergonomic stressors, such intensification of labor appears to lead to increases in musculoskeletal disorders. The evidence for adverse health effects remains inconclusive for related new work systems in other industries, such as modular manufacturing or patient-focused care. The discussion describes worker and union responses to such new systems of work organization, and implications for prevention, such as for "participatory ergonomics" programs.

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Web information

APHA web site: http://www.apha.org

To log onto the Members Only page of the APHA web site is your user name is: occhlth and the password is: rules.

Occupational Health Section web site can be reached through the APHA site, or you can go directly to it at: http://weber.u.washington.edu/~oshalert/

OSHALERT is our section e-mail distribution list to communicate timely information regarding important legislation and action alerts. To subscribe, send an email to: oshalert@u.washington.edu.

Contact information for the APHA Virtual Conference Project: Occupational Health Section Pilot: Michael Davies: mdavies@neuron.uchc.edu, 860-679-1869 or Tim Morse: 860-679-4720.

The Hotel Employees and Restaurant Employees website for find out where the union hotels are throughout the U.S.: http://www.hereunion.org/hotelguide/

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THE APHA POLICY FOR CORPORATE RELATIONS

By Craig Slatin, Sc.D., MPH, Secretary-elect

The text below was submitted as a letter from the Occupational Health Section to the APHA Executive Director and Executive Board and distributed to the Intersectional Council. (See the Chair’s Column for more on this.)

The Occupational Health Section takes issue with aspects of the interim policies for commercial support. Our comments and suggestions are stated below.

In the preamble to its Policy for Corporate Relations, APHA notes that in its 125 year history it "...has virtually no fund-raising or donor solicitation history." The Executive Board has determined that, despite this history, a Development Campaign is now necessary. A number of steps have been taken toward that aim. One has been a Development Feasibility Study conducted in late 1997. The Association notes that the results of this survey included a finding that "...corporations would like to contribute more to APHA, but that the Association seems to keep them at ‘arms length.'" The preamble to the policy also notes that although the Association "...would aggressively go after advertisements and exhibit sales that contribute significantly to its annual revenues..." it has not been open to donations and sponsorship funds. The preamble further states that advertising is "...reviewed for general consistency with APHA's policies."

In regard to those policies, we would like to comment upon the Association's acceptance of advertising. In 1997, the Occupational Health Section objected to a full-page advertisement that was placed on the inside cover of the AJPH. This advertisement was from the oil industry and declared the public health benefits of reformulated gasoline. The advertisement asserted that the industry was helping to reduce air pollution with this technology. Our objection to this advertisement included the following points

1. Development of effective and convenient mass public transportation systems, along with new models for urban/commercial/industrial planning and development, would be more appropriate measures for preventing air pollution than measures that facilitated the nation's persistent dependence upon automobiles and oil-based fuels. EPA statistics were indicating at the time that despite earlier emission control strategies, the phenomenal increase in automobile use in the U.S. had resulted in continuing high levels of air pollution that had adverse impacts upon the public health.

2. The substances which the industry were using to reformulate gasoline were likely to pose significant health hazards. This objection recently has been shown to be reasonable with the discovery that significant amounts of MBTE, a key reformulated gasoline ingredient, are now found in ground water in areas where reformulated gasoline has been in use. MBTE has caused cancer in animal laboratory studies and may be a human carcinogen.

This was an instance where the Association accepted substantial advertising funds from an industry that was using a stop-gap public health measure in order to avert a more substantial public health effort that would lead to a reduction in its control over the dominant mode of (polluting) transportation in the U.S., not to mention its profits. This ad was in direct opposition to a public health approach for preventing environmental-pollution-related illnesses and deaths. If the Association did adhere to its "policies" when accepting this advertisement, then those policies need serious review for consistency with public health principles.

The preamble lists several questions that were considered in developing the corporate donations policies. One question asked, "Is the corporate donor associated with interests or positions that are supportive of or directly counter to APHA's strategic goals and priority policies?" This raises troubling issues for us. How is that determination made? What are the criteria for making such determinations? The Association is a diverse body and represents a wide range of political view points. Some members and sections may believe that a corporation's labor and human rights practices must be considered when determining whether its business practices are consistent with public health principles, while other members may not believe that these are criteria for measuring consistency with public health practice. How then is the Executive Director to make decisions regarding corporate donations that are appropriate for the Association's members? The failure to have detailed criteria for decision-making can lead to practices that potentially can alienate members and sections.

The Overall Policy for Corporate Relations states the objective that accepted donations "...should advance APHA's strategic priorities while protecting the interest of the Association." We find it disturbing that APHA's strategic priorities may be different from its interests. The preamble notes this difference when it lists the building of the new headquarters building as a priority requiring external funding. The demands for a building fund may have required compromises of our principles.

Another objective of the Overall Policy is that in accepting donations, the Association will, neither seek nor accept funds "... from organizations whose activities are contrary to the public's health." Few U.S. corporations, if any, support progressive tax policies that provide greater opportunity for democratic decision-making regarding investment and distribution of accumulated capital. Yet many APHA members believe that such tax policies are an essential element for achieving maximum public health outcomes. Milton Terris, a former President of APHA has called for progressive taxation, eradication of poverty, universal free education, the best possible working and living conditions, and other social measures as a bedrock for public health. It is largely corporate opposition to these measures that block their establishment in the U.S., and thereby block achievement of public health goals.

Finally, the APHA Principles for Commercial Support or Donations fail to state that the Association will evaluate the acceptability of potential donors by social and corporate practices criteria that have been approved by a majority of Association members. Without such a principle, we believe that the other nine principles will fail to appropriately guide the decision-making of the Executive Director.

We believe that further consideration and debate is needed before we accept corporate donations. The existing guidelines do not seem adequate to avoid compromise of our public health principles.

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Deadline to submit articles to the editor for the next section newsletter is July 26^th. That will be the final newsletter before the annual conference.