Craig Slatin

Hospital injury rates in relation to socioeconomic status and working conditions.

Objectives: To describe the risk of work injury by socioeconomic status (SES) in hospital workers, and to assess whether SES gradient in injury risk is explained by differences in psychosocial, ergonomic or organisational factors at work. Methods: Workforce rosters and Occupational Safety and Health Administration injury logs for a 5-year period were obtained from two hospitals in Massachusetts. Job titles were classified into five SES strata on the basis of educational requirements and responsibilities: administrators, professionals, semiprofessionals, skilled and semiskilled workers. 13 selected psychosocial, ergonomic and organisational exposures were assigned to the hospital jobs through the national O*NET database. Rates of injury were analysed as frequency records using the Poisson regression, with job title as the unit of analysis. The risk of injury was modelled using SES alone, each exposure variable alone and then each exposure variable in combination with SES. Results: An overall annual injury rate of 7.2 per 100 full-time workers was estimated for the two hospitals combined. All SES strata except professionals showed a significant excess risk of injury compared with the highest SES category (administrators); the risk was highest among semiskilled workers (RR 5.3, p<0.001), followed by nurses (RR 3.7, p<0.001), semiprofessionals (RR 2.9, p = 0.006) and skilled workers (RR 2.6, p = 0.01). The risk of injury was significantly associated with each exposure considered except pause frequency. When workplace exposures were introduced in the regression model together with SES, four remained significant predictors of the risk of injury (decision latitude, supervisor support, force exertion and temperature extremes), whereas the RR related to SES was strongly reduced in all strata, except professionals. Conclusions: A strong gradient in the risk of injury by SES was reported in a sample population of hospital workers, which was greatly attenuated by adjusting for psychosocial and ergonomic workplace exposures, indicating that a large proportion of that gradient can be explained by differences in working conditions.

Conducting interdisciplinary research to promote healthy and safe employment in health care: promises and pitfalls.

Due to the complexity of human health, emphasis is increasingly being placed on the need for and conduct of multidisciplinary and/or interdisciplinary health research. Yet many academic and research organizations—and the discipline-specific associations and journals—may not yet be prepared to adopt changes necessary to optimally support interdisciplinary work. This article presents an ongoing interdisciplinary research projects efforts to investigate mechanisms and pathways that lead to occupational health disparities among healthcare workers. It describes the promises and pitfalls encountered during the research, and outlines effective strategies that emerged as a result. Lessons learned include: conflict resolution regarding theoretical and methodological differences; establishing a sense of intellectual ownership of the research, as well as guidelines for multiple authorship; and development and utilization of protocols, communication systems, and tools. This experience suggests a need for the establishment of supportive structures and processes to promote successful interdisciplinary research.

Effects of Social, Economic, and Labor Policies on Occupational Health Disparities

BACKGROUND This article introduces some key labor, economic, and social policies that historically and currently impact occupational health disparities in the United States. METHODS We conducted a broad review of the peer-reviewed and gray literature on the effects of social, economic, and labor policies on occupational health disparities. RESULTS Many populations such as tipped workers, public employees, immigrant workers, and misclassified workers are not protected by current laws and policies, including workers compensation or Occupational Safety and Health Administration enforcement of standards. Local and state initiatives, such as living wage laws and community benefit agreements, as well as multiagency law enforcement contribute to reducing occupational health disparities. CONCLUSIONS There is a need to build coalitions and collaborations to command the resources necessary to identify, and then reduce and eliminate occupational disparities by establishing healthy, safe, and just work for all.

Health Disparities Among Health Care Workers

In this article we describe the process of an interdisciplinary case study that examined the social contexts of occupational and general health disparities among health care workers in two sets of New England hospitals and nursing homes. A political economy of the work environment framework guided the study, which incorporated dimensions related to market dynamics, technology, and political and economic power. The purpose of this article is to relate the challenges encountered in occupational health care settings and how these could have impacted the study results. An innovative data collection matrix that guided small-group analysis provided a firm foundation from which to make design modifications to address these challenges. Implications for policy and research include the use of a political and economic framework from which to frame future studies, and the need to maintain rigor while allowing flexibility in design to adapt to challenges in the field.

Health and Safety Organizing: Ocaw's Worker-to-Worker Health and Safety Training Program

In 1987, the Oil, Chemical, and Atomic Workers International Union (OCAW) was funded as one of the original eleven awardees of the Superfund Worker Training Program of the National Institute of Environmental Health Sciences. The OCAW, with the Labor Institute, developed a hazardous waste worker and hazardous materials emergency responder health and safety training program that was specific to its members in the represented industries. A social history is developed to explore a union-led, worker health education intervention. The program sought to develop worker-trainers who would conduct the training, using the Small-Group Activity Method, participate in curriculum development, and ultimately use health and safety training as a vehicle for identifying, developing, and mobilizing health and safety activists among the membership. Although the direction for this effort came from progressive leadership, it arose from the political economy of labor/management relations within specific industrial sectors.

Joint occupational and environmental pollution prevention strategies: a model for primary prevention.

Occupational and environmental health issues are not always considered simultaneously when attempting to reduce or eliminate hazardous materials from our environment. Methods used to decrease exposure to hazardous chemicals in the workplace often lead to increased exposure in the environment and to the community outside the workplace. Conversely, efforts to control emissions of hazardous chemicals into the environment often lead to increased exposure to the workers inside the plant. There are government regulations in place that ensure a safe work environment or a safe outside environment; however, there is little integration of both approaches when considering the publics health as a whole. This article examines some of the reasons behind this dichotomy, focusing on the regulatory and policy frameworks with respect to workplace and environment that have resulted in the inability of the Occupational Safety and Health Administration (OSHA) and the Environmental Protection Agency (EPA) to coordinate their efforts to protect public health. The components of the Pollution Prevention Act and its potential to serve as a model for integrating occupational and environmental health are discussed. Limitations regarding enforcement of pollution prevention, as well as its disconnection from the work environment are equally highlighted. The article finishes by examining the barriers to integrating the occupational and environmental health paradigms and the promotion of primary prevention in public health.

AN ENERGY POLICY THAT PROVIDES CLEAN AND GREEN POWER

The oil and gas industry’s current promise of cheap natural gas supplies for the next century sounds remarkably like the promises of the 1950s about nuclear power. We were to gain cheap, abundant, and safe electricity for our homes, to expand industry for jobs, and to advance modern living. Nuclear electricity generation, however, has brought us the burden of subsidizing the high cost of nuclear facility construction and liability insurance, denial of ongoing radioactive releases, additional cancer burden, decades of fights over the transport and disposal of radioactive wastes, secrecy and lies from the industry and its government regulators, and multiple actual and near meltdowns. Now shale gas extraction conducted through the technological process commonly referred to as “fracking” is touted by the oil and gas industry as the next great energy boon. They tell us that gas will be so plentiful that it will answer all of our energy-related problems. Best yet, it will end the unemployment crisis that lingers past the Great Recession, leading to millions of jobs over the next several decades. Its promoters claim that we can have energy independence and a fuel that burns cleaner than coal—while they spread denial that the threat of catastrophic climate change is real or has much to do with human activity. Let’s not be deceived: shale gas extraction will neither fulfill the prophesies nor be useful in the transition to just, democratic, and ecologically sustainable economies across the globe. It is business as usual [1]. It is owned and operated by industries with more than a century’s legacy of greed, corruption, war provocation, pollution, illness, injury and death, environmental degradation, and a steady stream of propaganda and lobbying to limit its regulation by

Computer-Based Simulation in Blended Learning Curriculum for Hazardous Waste Site Worker Health and Safety Training

Intended for the interest of individuals and organizations who provide adult/worker training and education, we present a discussion of a computer-based simulation training tool used as part of a hazardous waste site worker health and safety training curriculum. Our objective is to present the simulations development, implementation, and assessment for learning utility from both trainee and trainer perspectives. The simulation is blended with other curriculum components of training courses and supports small group learning. Assessment included end-of-course trainee questionnaires and trainer focus groups to addressing simulation utility as a user-oriented learning tool. A majority of trainees reported simulation trainings as useful learning tools with numerous advantages that support a participatory, blended learning curriculum, and raise awareness of potential work site risks and hazards. Trainers reported that the simulation advanced training impact. Evaluation results indicate that the simulation successfully supports small group learning activities.

Nurses Respond to Healthcare Restructuring: The Transformation of the Massachusetts Nurses Association

Abstract The most recent period of Massachusetts healthcare system reorganization began in the early 1980s. In part, this has been a response to soaring healthcare costs, countering them with diminished reimbursements. To decrease labor costs and survive in an increasingly competitive and market-driven healthcare environment, hospitals downsized and laid off nursing staff. Patient care and safety has concomitantly suffered. These efforts severely challenged nurses status. Radicalized rank and file members of the Massachusetts Nurses Association mobilized against the association leaderships weak efforts to protect nurses social and economic interests and the deteriorating quality of care. They transformed an association whose main focus was supporting nursings professional image to one which became an activist labor union of professional workers. The history of this often contentious transformation is presented here within the context of these healthcare system changes. The MNAs successes and pending challenges within the Massachusetts healthcare system are also discussed.

No justice, no peace and the right to self-determination: an interview with Gary Grant and Naeema Muhammed of the North Carolina Environmental Justice Network.

This is an interview with Gary Grant and Naeema Muhammed, leaders of the North Carolina Environmental Justice Network. Each of them talks about where they grew up, their politicization, how their paths crossed, their work together after Hurricane Floyd, and the unique challenges of organizing for social justice for black communities in the South. We learn of their fight against concentrated animal feeding operations (CAFOs), primarily for the hog trade, and they take us up to North Carolinas Moral Monday protests of 2013 against legislation that threatens voting rights, public education, access to medical services, unemployment benefits, workers rights, occupational and environmental health, and womens access to reproductive health care. We are grateful to these two friends of New Solutions for their contribution to the journal, and we hope that their insights regarding struggles for social and environmental justice can serve as guides for us all.